Efficient adsorptive removal of levofloxacin using sulfonated graphene oxide: Adsorption behavior, kinetics, and thermodynamics

Water pollution by antibiotic residues poses a potential threat to environmental and human health. Graphene-based materials are highly stable, recyclable and effective adsorbents for efficiently removing antibiotics from polluted water. In this study, the adsorption behavior of levofloxacin onto sulfonated graphene oxide (SGO) was investigated by varying the contact period, solution pH, adsorbent quantity, levofloxacin concentration, inorganic ions, and solution temperature. Spectroscopic and microscopic techniques were employed to confirm the adsorptive interaction between levofloxacin and SGO. The adsorption process was most accurately characterized by the pseudo-second-order kinetic model and the Langmuir isotherm model, as indicated by their high correlation coefficients (R 2) and low root-mean-square error (RMSE) values. The maximal quantity of levofloxacin that can be adsorbed onto SGO was determined to be 1250 μmol/g at pH 4 and 25 °C using the Langmuir model. Thermodynamic studies reveal that the process of levofloxacin adsorption onto SGO is endothermic and spontaneous in nature. Taking into consideration the results of adsorption, desorption and regeneration studies, it is proposed that SGO can be applied as an economic viable agent for the adsorptive removal of levofloxacin from the aqueous environment.

Comparative analysis of size-fractional eukaryotic microbes in subtropical riverine systems inferred from 18S rRNA gene V4 and V9 regions

Eukaryotic microbes play key ecological roles in riverine ecosystems. Amplicon sequencing has greatly facilitated the identification and characterization of eukaryotic microbial communities. Currently, 18S rRNA gene V4 and V9 hypervariable regions are widely used for sequencing eukaryotic microbes. Identifying optimal regions for the profiling of size-fractional eukaryotic microbial communities is critical for microbial ecological studies. In this study, we spanned three rivers with typical natural-human influenced transition gradients to evaluate the performance of the 18S rRNA gene V4 and V9 hypervariable regions for sequencing size-fractional eukaryotic microbes (>180 μm, 20-180 μm, 5-20 μm, 3-5 μm, 0.8-3 μm). Our comparative analysis revealed that amplicon results depend on the specific species and microbial size. The V9 region was most effective for detecting a broad taxonomic range of species. The V4 region was superior to the V9 region for the identification of microbes in the minor 3 μm and at the family and genus levels, especially for specific microbial groups, such as Labyrinthulomycetes. However, the V9 region was more effective for studies of diverse eukaryotic groups, including Archamoebae, Heterolobosea, and Microsporidia, and various algae, such as Haptophyta, Florideophycidae, and Bangiales. Our results highlight the importance of accounting for potential misclassifications when employing both V4 and V9 regions for the identification of microbial sequences. The use of optimal regions for amplification could enhance the utility of amplicon sequencing in environmental studies. The insights gained from this work will aid future studies that employ amplicon-based identification approaches for the characterization of eukaryotic microbial communities and contribute to our understanding of microbial ecology within aquatic systems.

Biotechnological potential of salt tolerant and xerophilic species of Aspergillus

Xerophilic fungi occupy versatile environments owing to their rich arsenal helping them successfully adapt to water constraints as a result of low relative humidity, high-osmolarity, and high-salinity conditions. The general term xerophilic fungi relates to organisms that tolerate and/or require reduced water activity, while halophilic and osmophilic are applied to specialized groups that require high salt concentrations or increased osmotic pressure, respectively. Species belonging to the family Aspergillaceae, and especially those classified in Aspergillus subgenus Aspergillus (sections Restricti and Aspergillus) and Polypaecilum, are particularly enriched in the group of osmophilic and salt-tolerant filamentous fungi. They produce an unprecedently wide spectrum of salt tolerant enzymes including proteases, peptidases, glutaminases, γ-glutamyl transpeptidases, various glycosidases such as cellulose-decomposing and starch-degrading hydrolases, lipases, tannases, and oxidareductases. These extremophilic fungi also represent a huge untapped treasure chest of yet-to-be-discovered, highly valuable, biologically active secondary metabolites. Furthermore, these organisms are indispensable agents in decolorizing textile dyes, degrading xenobiotics and removing excess ions in high-salt environments. They could also play a role in fermentation processes at low water activity leading to the preparation of daqu, meju, and tea. Considering current and future agricultural applications, salt-tolerant and osmophilic Aspergilli may contribute to the biosolubilization of phosphate in soil and the amelioration salt stress in crops. Transgenes from halophile Aspergilli may find promising applications in the engineering of salt stress and drought-tolerant agricultural crops. Aspergilli may also spoil feed and food and raise mycotoxin concentrations above the permissible doses and, therefore, the development of novel feed and food preservation technologies against these Aspergillus spp. is also urgently needed. On the other hand, some xerophilic Aspergilli have been shown to be promising biological control agents against mites. KEY POINTS: • Salt tolerant and osmophilic Aspergilli can be found in versatile environments • These fungi are rich resources of valuable enzymes and secondary metabolites • Biotechnological and agricultural applications of these fungi are expanding.

Disposal of Unused Antibiotics in Community Pharmacies in Saudi Arabia: A Mixed-Methods Study

Introduction

Improper disposal of unused antibiotics poses a significant global challenge, drawing attention from various stakeholders. This discharge of antibiotics into the environment can occur through various means such as industrial production, consumption, and excretion by humans and animals, as well as improper disposal of unused or expired antibiotics. The aim of our study is to investigate the availability of proper disposal of antibiotics in community pharmacies and to explore obstacles and opportunities from pharmacist's point of view.

Methods

This study used a mixed-methods approach that consisted of two study arms: quantitative and qualitative. The quantitative arm used a mystery-shopper method for assessing the disposal of antibiotics in community pharmacies. The qualitative study arm consisted of several in-depth semi-structured focus groups with a sample of pharmacists working in community pharmacies in Riyadh.

Results

The mystery shopper arm showed that 85% (n=88) refused to take the return of antibiotics. Interviews with pharmacists have indicated a lack of knowledge on safe disposal methods for antibiotics and medications. Additionally, pharmacists have cited several factors contributed to accumulation of the antibiotics such as nonadherence or policies mandating the sale of whole medication packs instead of the required amounts as a contributing factor to this issue. Furthermore, there is a lack of dedicated facilities for the population to safely dispose of their medications and/antibiotics.

Conclusion

By acknowledging the factors contributing to improper disposal practices, recognizing the importance of proper antibiotic disposal, and advocating for multi-faceted initiatives, we can work towards mitigating this critical issue. Through collaborative efforts involving education, policy interventions, and community engagement, we can foster a culture of responsible medication disposal, ultimately safeguarding public health and environmental well-being.

Genetic Insights on Meropenem Resistance Concerning Klebsiella pneumoniae Clinical Isolates

The transferable genetic elements are associated with the dissemination of virulence determinants amongst Klebsiella pneumoniae. Thus, we assessed the correlated antimicrobial resistance in carbapenem-resistant Klebsiella pneumoniae clinical isolates. Each isolate's ability to biosynthesize biofilm, carbapenemase, and extended-spectrum β-lactamase were examined. Genotypically, the biofilm-, outer membrane porin-, and some plasmid-correlated antimicrobial resistance genes were screened. About 50% of the isolates were multidrug-resistant while 98.4% were extended-spectrum β-lactamase producers and 89.3% were carbapenem-resistant. Unfortunately, 93.1% of the multidrug-resistant isolates produced different biofilm levels. Additionally, fimD and mrkD genes encoding adhesins were detected in 100% and 55.2% of the tested isolates, respectively. Also, the blaKPC, blaOXA-48-like, and blaNDM-encoding carbapenemases were observed in 16.1%, 53.6%, and 55.4% of the tested isolates, respectively. Moreover, the blaSHV and blaCTX-M extended-spectrum β-lactamase-associated genes were detected at 95.2% and 61.3%, respectively. Furthermore, aac(3)IIa, qnrB, and tetB resistance-correlated genes were observed in 38.1%, 46%, and 7.9% of the tested isolates, respectively. Certainly, the tested antimicrobial resistance-encoding genes were concurrently observed in 3.2% of the tested isolates. These findings confirmed the elevated prevalence of various antimicrobial resistance-associated genes in Klebsiella pneumoniae. The concurrent transferring of plasmid-encoding antimicrobial resistance-related genes could be associated with the possible acquisition of multidrug-resistant Klebsiella pneumoniae phenotypes.

Antimicrobial Stewardship in Healthcare: Exploring the Role of Nurses in Promoting Change, Identifying Barrier Elements and Facilitators-A Meta-Synthesis

BACKGROUND

Antimicrobial stewardship (AMS) involves a coordinated set of actions aimed at promoting the appropriate use of antibiotics within healthcare settings. This systematic review of qualitative studies assessed nurses' knowledge and perceptions of the barriers and facilitators that impact their involvement in AMS programs.

METHODS

This meta-synthesis followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. Relevant studies published between 2018 and 2023 were identified through searches on PubMed, CINAHL, EMBASE, PsycINFO, and Google Scholar. The studies were critically appraised using the CASP checklist, with 19 articles meeting the inclusion criteria from five continents.

RESULTS

Six recurring themes emerged from the analysis of nurses' experiences and opinions regarding their roles in AMS programs. These themes included the organization of AMS programs, availability of resources, training and education, communication, and the evolving role of nurses in AMS.

CONCLUSIONS

Nurses at every level of the profession might play a crucial role in antimicrobial stewardship. Although active involvement of nurses in antibiotic stewardship requires further exploration and research, this topic is being examined internationally. The literature on this subject primarily analyzes the phenomenon from a quantitative perspective rather than a qualitative one, and it is contextualized more within hospital settings rather than community settings.

Exploring the biosorption of nickel and lead by Fusarium sp. biomass: kinetic, isotherm, and thermodynamic assessment

Fungal biomass is as a cost-effective and sustainable biosorbent utilized in both active and inactive forms. This study investigated the efficacy of inactivated and dried biomass of Fusarium sp. in adsorbing Ni2+ and Pb2+ from aqueous solutions. The strain underwent sequential cultivation and was recovered by filtration. Then, the biomass was dried in an oven at 80 ± 2 °C and sieved using a 0.1-cm mesh. The biosorbent was thoroughly characterized, including BET surface area analysis, morphology examination (SEM), chemical composition (XRF and FT-IR), thermal behavior (TGA), and surface charge determination (pH-PZC and zeta potential). The biosorption mechanism was elucidated by fitting equilibrium models of kinetics, isotherm, and thermodynamic to the data. The biosorbent exhibited a neutral charge, a rough surface, a relatively modest surface area, appropriate functional groups for adsorption, and thermal stability above 200 °C. Optimal biosorption was achieved at 25 ± 2 °C, using 0.05 g of adsorbent per 50 mL of metallic ion solution at initial concentrations ranging from 0.5 to 2.0 mg L-1 and at pH 4.5 for Pb2+ and Ni2+. Biosorption equilibrium was achieved after 240 min for Ni2+ and 1440 min for Pb2+. The process was spontaneous, mainly through chemisorption, in monolayer for Ni2+ and multilayer for Pb2+, with efficiencies of over 85% for both metallic ion removal. These findings underscore the potential of inactive and dry Fusarium sp. biomass (IDFB) as a promising material for the biosorption of Ni2+ and Pb2+.

Characterization, Antibiotic Susceptibility, and Clonal Analysis of Carbapenem-Resistant Klebsiella pneumoniae From Different Clinical Cases

INTRODUCTION

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is recognized for its great ability to resist prescription drugs and its association with severe infections in humans.

OBJECTIVES

This study was designed to evaluate the characteristic resistance spectrum, to characterize the implicated carbapenem-resistant genes (CRGs), and to determine the extent of genetic diversity among Klebsiella pneumoniae isolates from human clinical cases in Duhok province.  Methodology: The VITEK-2 system was used to investigate the phenotypic antibiotic susceptibility of 23 K. pneumoniae isolated from distinct human clinical situations, multiplex PCR was used to assign the key common carbapenem-resistant genes (IMP, OXA48-like, bla-NDM, and KPC) in phenotypically carbapenem-resistant isolates, and the Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) assay was utilized to ascertain the clonal associations among those isolates.

RESULTS

Phenotypic resistance analysis revealed high resistance rates to various antibiotics, with all isolates exhibiting multidrug resistance (MDR). Coronavirus disease 2019 (COVID-19) patient isolates demonstrated significantly higher resistance compared to other sources. In addition, all isolates showed complete phenotypic resistance to carbapenems, PCR screening for CRGs identified blaOXA-48 as the predominant gene, present in all isolates. Genetic fingerprinting revealed diverse genotypes, with COVID-19 patient isolates exhibiting high similarity, contrasting with maximum diversity in non-COVID-19 clinical isolates.

Genome Analysis of Potential Probiotic Levilactobacillus brevis AcCh91 Isolated from Indian Home-Made Fermented Milk Product (Chhurpi)

Consumption of naturally fermented milk (NFM) products is the dietary culture in India. The mountainous people of Arunachal Pradesh in India prepare the assorted artisanal home-made NFM products from cow and yak milk. Previously, we isolated and identified 76 strains of lactic acid bacteria (LAB) from NFM products of Arunachal Pradesh, viz. mar, chhurpi and churkam. We hypothesized that some of these LAB strains may possess probiotic potentials; hence, we investigated the probiotic potentials of these strains. On the basis of in vitro and genetic screening for probiotic attributes including haemolytic ability, 20 LAB strains were selected out of 76 strains, for further analysis. Using in silico analysis, viz. multivariate heatmap and PCA (principal component analysis) biplot, Levilactobacillus brevis AcCh91 was selected as the most promising probiotic strain, which was further characterized by the whole-genome analysis. Lev. brevis AcCh91 showed the highest survival rate of 93.38% in low pH and 86.68 ± 2.69% in low bile and the highest hydrophobicity average of 86.34 ± 5.53%. This strain also showed auto-aggregation and co-aggregation with antimicrobial properties against the pathogens, showed ability to produce beta-galactosidase and cholesterol reduction property and, most importantly, produced GABA, an important psychobiotic element. Genomic analysis of Lev. brevis AcCh91 showed the presence of genes corresponding to GABA, vitamins, amino acids, cholesterol reduction, immunomodulation, bioactive peptides and antioxidant activity. The absence of antimicrobial-resistant genes and virulence factors was observed. Hence, genome analysis supports the probiotic potentials of Lev. brevis AcCh91, which may be further investigated to understand its health-promoting properties.

Prevalence and Molecular Epidemiology of Intestinal Colonization by Multidrug-Resistant Bacteria among Hematopoietic Stem-Cell Transplantation Recipients: A Bulgarian Single-Center Study

Background/Objectives: Intestinal colonization by multidrug-resistant (MDR) bacteria is considered one of the main risk factors for invasive infections in the hematopoietic stem-cell transplant (HSCT) setting, associated with hard-to-eradicate microorganisms. The aim of this study was to assess the rate of intestinal colonization by MDR bacteria and their microbial spectrum in a group of post-HSCT patients to study the genetic determinants of beta-lactam and glycopeptide resistance in the recovered isolates, as well as to determine the epidemiological relation between them. Methods: The intestinal colonization status of 74 patients admitted to the transplantation center of University Hospital "St. Marina"-Varna in the period January 2019 to December 2021 was investigated. Stool samples/rectal swabs were screened for third-generation cephalosporin and/or carbapenem-resistant Gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Stenotrophomonas maltophilia. Identification and antimicrobial susceptibility testing were performed by Phoenix (BD, Sparks, MD, USA) and MALDI Biotyper sirius (Bruker, Bremen, Germany). Molecular genetic methods (PCR, DNA sequencing) were used to study the mechanisms of beta-lactam and glycopeptide resistance in the collected isolates, as well as the epidemiological relationship between them. Results: A total of 28 patients (37.8%) were detected with intestinal colonization by MDR bacteria. Forty-eight non-duplicate MDR bacteria were isolated from their stool samples. Amongst them, the Gram-negative bacteria prevailed (68.8%), dominated by ESBL-producing Escherichia coli (30.3%), and followed by carbapenem-resistant Pseudomonas sp. (24.2%). The Gram-positive bacteria were represented exclusively by Enterococcus faecium (31.2%). The main beta-lactam resistance mechanisms were associated with CTX-M and VIM production. VanA was detected in all vancomycin-resistant enterococci. A clonal relationship was observed among Enterobacter cloacae complex and among E. faecium isolates. Conclusions: To the best of our knowledge, this is the first Bulgarian study that presents detailed information about the prevalence, resistance genetic determinants, and molecular epidemiology of MDR gut-colonizing bacteria in HSCT patients.

Extent and causes of unused medications among patients in rural Ethiopia: a prospective multicenter cohort study

BACKGROUND

Medication waste poses health, economic, and environmental challenges. However, the extent among patients living in rural areas is underexplored. This study assessed the proportion of prescribed medications remaining unused by patients living in rural areas of Ethiopia, and identify the causes thereof and disposal practices.

METHODS

A prospective multicenter cohort study was conducted in 5 rural health centers in Ethiopia. Patients (≥ 18 years), who received a prescription for acute or chronic medication for pick up from the outpatient pharmacy were included. After 3 months, participants received a house visit by a health employee during which a questionnaire was verbally administered to assess the quantity of unused medication, reason thereof, and disposal practices used. Data were analyzed using descriptive statistics and multivariate logistic regression to identify factors associated with presence of unused medications.

RESULTS

In total, 178 patients participated. Up to 136 out of 601 (22.6%) dispensed medications ended up unused, mainly antibiotics and analgesics, with an average economic value of $0.37. Of 178 patients, 72 (40.4%) ended up with unused medication, and 15 (8.4%) did not use 80% or more of the prescribed quantity. Early discontinuation of therapy was the main reason (61.8%) for patients' ending with unused medication. Patients reported to primarily dispose of unused medication either through the toilet (43.6%), household garbage (22.7%), burning (13.6%), or returning it to the pharmacy (2.7%). Medications dispensed to be administered with two or more-unit doses at a time were more likely to remain unused (adjusted OR 1.6 [1.0-3.4]) compared to medications dispensed to be administered one-unit dose.

CONCLUSION

A substantial amount of prescribed medications remains unused by patients in rural areas, frequently not properly disposed. Interventions are needed to ensure medications are not wasted and reduce the unwanted consequences.

Evaluation of Agronomic Traits, Total Phenolic Content, and Antioxidant Properties of Sesame Seeds of Different Colors and Origin

Rising health concerns regarding chronic diseases call for exploring natural sources of antioxidants and factors that influence their activity. This study evaluated the diversity of 112 sesame germplasms from Africa and Asia based on ten agronomic traits (seven quantitative and three qualitative), two antioxidant activities (ABTS and DPPH radical scavenging activities), and the content of one metabolite (TPC). TPC, DPPH, and ABTS were in the ranges of 4.98-87.88 µg GAE/mg DE, 3.97-46.23 µg AAE/mg DE, and 3.42-176.01 µg TE/mg DE, respectively. Statistical analyses revealed significant variations in agronomic traits, TPC, and antioxidant activities among the sesame germplasms (p < 0.05). Furthermore, the individual and interaction effects of seed color and the continent of origin on the levels of the quantitative traits, TPC, ABTS, and DPPH were analyzed, and the correlation among the traits was further evaluated. Diversity in TPC, ABTS, and DPPH was significantly associated with seed color and most of the quantitative agronomic traits (p < 0.05) but not with continent of origin. Principal component analysis revealed TPC, ABTS, DPPH, and five quantitative traits as the most discriminant traits. In general, six sesame accessions with high TPC and antioxidant activities (IT194356, IT170094, IT29971, IT185998, IT104246, and IT169623) as well as important agronomic traits were identified and, hence, could be used for developing improved sesame varieties.

Unveiling heavy metal pollution dynamics in sediments of river Ulhas, Maharashtra, India: a comprehensive analysis of anthropogenic influence, pollution indices, and health risk assessment

Metals and metalloids tainting sediments is an eminent issue, predominantly in megacities like Mumbai and Navi Mumbai, requiring an exhaustive examination to identify metal levels in river bodies that serve various populations. Thus, utilising pollution indices, multivariate analysis, and health risk assessment studies, we propose a novel investigation to examine the metal content in the Ulhas River sediments, a prominent agricultural and drinking water supply (320 million-litre per day) near Mumbai in Maharashtra, India. The eleven metals and metalloids (As, Cd, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, and Zn) were examined monthly from 10 stations totaling 120 sediment specimens from October 2022 to September 2023. Investigations revealed that average values of Cr, Cu, Hg, and Ni exceeded Australian and New Zealand Environment and Conservation Council and Agriculture and Resource Management Council values, while all metals exceeded World surface rock average limits except As. Various pollution indices showed that upstream sites had none to low level contamination, whereas downstream locations had moderate to considerable contamination, suggesting anthropogenic influences. Furthermore, multivariate analysis including correlation, cluster, and principal component analysis identified that sediment pollution was mostly caused by anthropogenic activities. Lastly, health risk assessment indicated Fe was non-carcinogenic to children, whereas Cr and Ni were carcinogenic to children and adults, with children being more susceptible. Thus, from the findings of the study it is clear that, despite low to moderate pollution levels, metals may have significant repercussions, thus requiring long-term planning, frequent monitoring, and metal abatement strategies to mitigate river contamination.

Antibiotic resistance: a global crisis, problems and solutions

Healthy state is priority in today's world which can be achieved using effective medicines. But due to overuse and misuse of antibiotics, a menace of resistance has increased in pathogenic microbes. World Health Organization (WHO) has announced ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) as the top priority pathogens as these have developed resistance against certain antibiotics. To combat such a global issue, it is utmost important to identify novel therapeutic strategies/agents as an alternate to such antibiotics. To name certain antibiotic adjuvants including: inhibitors of beta-lactamase, efflux pumps and permeabilizers for outer membrane can potentially solve the antibiotic resistance problems. In this regard, inhibitors of lytic domain of lytic transglycosylases provide a novel way to not only act as an alternate to antibiotics but also capable of restoring the efficiency of previously resistant antibiotics. Further, use of bacteriophages is another promising strategy to deal with antibiotic resistant pathogens. Taking in consideration the alternatives of antibiotics, a green synthesis nanoparticle-based therapy exemplifies a good option to combat microbial resistance. As horizontal gene transfer (HGT) in bacteria facilitates the evolution of new resistance strains, therefore identifying the mechanism of resistance and development of inhibitors against it can be a novel approach to combat such problems. In our perspective, host-directed therapy (HDT) represents another promising strategy in combating antimicrobial resistance (AMR). This approach involves targeting specific factors within host cells that pathogens rely on for their survival, either through replication or persistence. As many new drugs are under clinical trials it is advisable that more clinical data and antimicrobial stewardship programs should be conducted to fully assess the clinical efficacy and safety of new therapeutic agents.

Very Low Calorie Ketogenic Diet: What Effects on Lipid Metabolism?

PURPOSE OF REVIEW

This review aims to critically examine how VLCKD affects plasma lipoprotein, lipid and cholesterol metabolism. Cardiovascular disease is a worldwide health problem affecting millions of people and leading to high rates of mortality and morbidity. There is a well-established association between cardiovascular disease and circulating cholesterol. Various dietary recommendations are currently available for the management of dyslipidemia.

RECENT FINDINGS

The very low-calorie ketogenic diet (VLCKD) is becoming increasingly popular as a treatment option for several pathological conditions, including dyslipidemia. In addition to being low in calories, the VLCKD's main feature is its unique calorie distribution, emphasizing a reduction in carbohydrate consumption in favor of fat as the primary calorie source. Lowering calorie intake through a VLCKD can reduce the endogenous production of cholesterol. However, if the foods consumed are from animal sources, dietary cholesterol intake may increase due to the higher fat content of animal products. When combined, these dietary practices may have opposing effects on plasma cholesterol levels. Studies investigating the impact of VLCKD on plasma cholesterol and low-density lipoprotein cholesterol levels report contradictory findings. While some studies found an increase in low-density lipoprotein cholesterol levels, others showed a decrease in total cholesterol and low-density lipoprotein cholesterol, along with an increase in high-density lipoprotein cholesterol.

Effects of Zinc Compounds on Lysozyme, Peroxidase, and α-Amylase from the Perspective of Oral Health: a Scoping Review

Zinc has been proposed as a topical therapeutic agent for the prevention and treatment of various oral diseases. The purpose of this scoping review was to investigate the effects of zinc on the enzymatic activities of lysozyme, peroxidase, and α-amylase from the perspective of developing oral health care products and therapeutic agents for oral diseases. A comprehensive review of the scientific literature was conducted on the direct interactions of zinc with lysozyme, peroxidase, and α-amylase from various sources. Most of the reports on the effects of zinc on the enzymatic activities of lysozyme, peroxidase, and α-amylase involved enzymes derived from bacteria, fungi, animals, and plants. Studies of human salivary enzymes were scarce. Zinc was found to inhibit the enzymatic activities of lysozyme, peroxidase, and α-amylase under diverse experimental conditions. The suggested mechanism was ionic interactions between zinc and enzyme molecules. The possibility that zinc causes structural changes to enzyme molecules has also been suggested. In conclusion, for zinc to be used as an effective topical therapeutic agent for oral health, further studies on the activity of human salivary enzymes are warranted, and additional information regarding the type and concentration of effective zinc compounds is also required.

Antibiotic resistance rates in hypervirulent Klebsiella pneumoniae strains: A systematic review and meta-analysis

OBJECTIVES

In response to the growing global concerns regarding antibiotic resistance, we conducted a meta-analysis to assess the prevalence of antibiotic resistance in hypervirulent Klebsiella pneumoniae (hvKp) strains.

METHODS

We conducted a meta-analysis of antibiotic resistance in the hvKp strains. Eligible studies published in English until April 10, 2023, were identified through a systematic search of various databases. After removing duplicates, two authors independently assessed and analysed the relevant publications, and a third author resolved any discrepancies. Data extraction included publication details and key information on antibiotic resistance. Data synthesis employed a random-effects model to account for heterogeneity, and various statistical analyses were conducted using R and the metafor package.

RESULTS

This meta-analysis of 77 studies from 17 countries revealed the prevalence of antibiotic resistance in hvKp strains. A high resistance rates have been observed against various classes of antibiotics. Ampicillin-sulbactam faced 45.3% resistance, respectively, rendering them largely ineffective. The first-generation cephalosporin cefazolin exhibited a resistance rate of 38.1%, whereas second-generation cefuroxime displayed 26.7% resistance. Third-generation cephalosporins, cefotaxime (65.8%) and ceftazidime (57.1%), and fourth-generation cephalosporins, cefepime (51.3%), showed substantial resistance. The last resort carbapenems, imipenem (45.7%), meropenem (51.0%) and ertapenem (40.6%), were not spared.

CONCLUSION

This study emphasizes the growing issue of antibiotic resistance in hvKp strains, with notable resistance to both older and newer antibiotics, increasing resistance over time, regional disparities and methodological variations. Effective responses should involve international cooperation, standardized testing and tailored regional interventions.

The management of unused and expired medications in Thai households: Influencing factors and prevailing practices

OBJECTIVE

Although the improper disposal of unused and expired medications represents a global environmental concern, its significance is often underestimated. This research delves into the practices and factors related to the management of unused and expired medications.

METHODS

Data was collected through a comprehensive survey of Thai households, with 400 structured questionnaires. Multiple regression was then employed to analyze the data.

RESULTS

Findings show an intriguing paradox. The participants in the survey demonstrated commendable knowledge regarding the appropriate management of unused or expired medications. Yet, this knowledge was not sufficiently put into practice. This study identifies the factors that have a positive influence on proper medication disposal practices, such as age, level of education, attitude, and perception. Surveyed participants exhibited a tendency to retain unused medications and discard expired ones with household waste. Most of them showed a low degree of medication management, pointing to the need for targeted interventions.

CONCLUSION

This research provides tangible benefits for policymakers, healthcare practitioners, and researchers addressing waste management paradigms. In terms of policy, the study highlights the need for comprehensive interventions, including medication take-back systems, infrastructure development, and educational initiatives. Policymakers are urged to bridge the gap between knowledge and behavior by promoting access to collection points for proper medication disposal to avoid perpetuating the cycle of suboptimal medication management. This research informs strategies to encourage responsible medication management practices globally, addressing the adverse environmental and health impacts associated with the improper accumulation of medications.

Antimicrobial use in laboratory rodent facilities in Australia and New Zealand- a cross-sectional survey of veterinarians and facility managers

This cross-sectional study surveyed veterinarians and facility managers to characterise the use of antimicrobials in laboratory rodent facilities within Australia and New Zealand. Most facilities (71%) reported routine administration of antimicrobials. The indications for antibiotic use reflected those described in publications and differed significantly to reasons for use in non-laboratory animals. Antimicrobials used include those of critical importance to human health, and access to these drugs is unregulated, as prescription-only classes are ordered through research catalogues, without human or veterinary physician prescriptions. The ways in which antimicrobials are used in Australian and New Zealand rodent facilities are likely contributing to antimicrobial resistance within rodent populations, particularly as they are largely administered in drinking water, risking subtherapeutic dosing. Much antimicrobial use reported is unnecessary and could be replaced with changes to husbandry and handling. The generation of resistance in both pathogenic and commensal microbes may also represent a work health and safety issue for humans working with these animals. Reported disposal of antimicrobials included discharge into wastewater, without inactivation, and some respondents reported disposal of substrate, or soiled bedding, nesting material, and disposable enrichment items, from treated animals and medicated feed into landfill, without prior inactivation. Environmental contamination with resistant microbes and antimicrobials is a significant driver of antimicrobial resistance. As such, significant opportunities exist to implement judicious and responsible use of antimicrobials within research rodent facilities in Australia and New Zealand, with a particular focus on instituting aseptic surgery, optimising dosing regimens, and inactivation of medicated water and substrate before disposal.

Occurrence, antimicrobial resistance and genomic features of Klebsiella pneumoniae from broiler chicken in Faisalabad, Pakistan

Introduction

The dissemination of antimicrobial resistance (AMR) in critical priority pathogens is a significant threat. Non-clinical reservoirs of AMR, such as agriculture and food production facilities, may contribute to the transmission of clinically relevant pathogens such as multidrug-resistant (MDR) Klebsiella pneumoniae. There is currently very limited knowledge regarding the population structure and genomic diversity of K. pneumoniae in poultry production in Pakistan.

Methods

We explored healthy broilers in a commercial farm from Faisalabad, Pakistan, and identified six K. pneumoniae strains from 100 broiler birds. We characterized the strains, determining clonality, virulence and antimicrobial resistance genes using next generation sequencing.

Results

The evaluation of antimicrobial susceptibility revealed that all the strains were MDR. Genomic analysis showed that 3/6 strains belonged to ST152, harbouring acquired resistance aminoglycosides [aadA2, aph(4')-Ia], β-lactams (blaSHV-187 , blaLAP2 ), fosfomycin (fosA6), tetracycline (tetA), trimethoprim (dfrA12), quinolone (qnrS1), sulphonamides (sul2) and phenicol (floR). All the strains harboured the efflux pump genes oqxA, oqxB, emrR, kpnG, kpnH, kpnF, baeR, mtdB and mtdC. All six strains encoded identical virulence profiles possessing six genes, i.e., ureA, iutA, entB, allS, fimH and mrkD. Phylogenomic analysis of the dominant sequence type (ST152) present in our dataset with publicly available genomes showed that the isolates clustered to strains mainly from human sources and could pose a potential threat to food safety and public health.

Discussion

The combination of these findings with antimicrobial use data would allow a better understanding of the selective pressures that may be driving the spread of AMR. This is the first report of MDR K. pneumoniae isolated from broiler hens in Pakistan, and the finding suggests that routine surveillance of WHO critical priority pathogens in such settings would be beneficial to the development of effective control strategies to reduce AMR.

Investigating the effect of solvent on anti-antioxidant properties of Sesamum indicum seeds

Dietary phytochemicals are important bioactive compounds that can scavenge reactive oxygen species. These essential compounds may have antioxidant properties which are known to play a significant role in the treatment and prevention of many chronic diseases. Sesame, an oil-bearing seed, is a well-known promising source of food with both nutritional and therapeutic benefits. As a result, the study aimed to evaluate the antioxidant properties of different solvent extracts of Sesame seeds and to analyse the bioactive compounds present. The seeds were obtained from the local farmers and prepared for analysis. The bioactive compounds present in the seeds were extracted using hexane, ethyl acetate, ethanol, and water. The total phenolic content (TPC), the condensed tannin content (CTC), the total antioxidant capacity (TAC), and the 2,2-Diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay were also determined using standard methods. Two chemometric methods, hierarchical cluster analysis (HCA) and Pearson correlation, were employed to evaluate the interdependence of the various parameters and the antioxidant activity. Anti-nutrients such as saponins, alkaloids, phytates, and oxalates were also analysed from the powdered seeds. The study results revealed the presence of anti-nutrients such as phytate (7.691 ± 0.8576 mg/g), oxalate (1.501 ± 0.1375 mg/g), saponins (21.33 ± 4.619 mg/g) and alkaloids (317.33 ± 30.29 mg/g). The study also revealed that the aqueous extract exhibited the highest TPC (17.12 ± 0.041 mg GAE/g of dried extract, p < 0.05) and CTC (64.27 ± 4.711 mg CE/g of dried extract, p < 0.05). Ethanol and hexane had a similar total phenolic content (14.83 ± 0.123 and 14.66 ± 1.474 mg GAE/g of dried extract, respectively, p < 0.05Ethyl acetate had the lowest TPC content. Ethanol extracts had the highest antioxidant activity with a TAC value of 232.6 ± 6.267 mg/g AAE and a DPPH scavenging activity of IC50 of 52.81 ± 2.30 μg/mL. A good correlation (p < 0.05) was established between the extracts' TPC, CTC, TAC, and DPPH radical scavenging activity. Chemometric analysis from the study showed no significant connection between the radical scavenging activity of TPC and DPPH. From the results obtained, it can be concluded that the bioactive compounds present in the sesame seed and their subsequent antioxidant properties are dependent on the nature of the solvent used for extraction.

Cytotoxicity of Benzofuran-Containing Simplified Viniferin Analogues

Within the huge class of plant secondary metabolites, resveratrol-derived stilbenoids show wide structural diversity and mediate a great number of biological responses relevant for human health, including cancer prevention and cytotoxicity. Resveratrol is known to modulate several pathways directly linked to cancer progression, as well as its analogue pterostilbene, characterized by an increased metabolic stability and significant pharmacological activities. To study the potential anticancer activity of other stilbenoids, a home-made collection of resveratrol dimers and simplified analogues was tested on melanoma A375, non-small cell lung cancer H460 and PC3 prostate cancer cell lines. The structural determinants responsible for the antiproliferative activity have been highlighted. Moreover, to investigate the DNA damage ability of the selected molecules, the expression of the γ-H2AX after compound exposure was evaluated.

Review on antibiotic pollution dynamics: insights to occurrence, environmental behaviour, ecotoxicity, and management strategies

Antibiotic contamination poses a significant global concern due to its far-reaching impact on public health and the environment. This comprehensive review delves into the prevalence of various antibiotic classes in environmental pollution and their interactions with natural ecosystems. Fluoroquinolones, macrolides, tetracyclines, and sulphonamides have emerged as prevalent contaminants in environmental matrices worldwide. The concentrations of these antibiotics vary across diverse environments, influenced by production practices, consumer behaviours, and socio-economic factors. Low- and low-middle-income countries face unique challenges in managing antibiotic contamination, with dominant mechanisms like hydrolysis, sorption, and biodegradation leading to the formation of toxic byproducts. Ecotoxicity reports reveal the detrimental effects of these byproducts on aquatic and terrestrial ecosystems, further emphasizing the gravity of the issue. Notably, monitoring the antibiotic parent compound alone may be inadequate for framing effective control and management strategies for antibiotic pollution. This review underscores the imperative of a comprehensive, multi-sectoral approach to address environmental antibiotic contamination and combat antimicrobial resistance. It also advocates for the development and implementation of tailored national action plans that consider specific environmental conditions and factors. Thus, an approach is crucial for safeguarding both public health and the delicate balance of our natural ecosystems.

Recent advance in sesame allergens: Influence of food processing and their detection methods

Sesame (Sesamum indicum L.) is a valuable oilseed crop with numerous nutritional benefits containing a diverse range of bioactive compounds. However, sesame is also considered an allergenic food that triggers various mild to severe adverse reactions (e.g., anaphylaxis). Strict dietary avoidance of sesame components is the best option to protect the sensitized consumers. Sesame or sesame-derived foods are always consumed after certain food processing operations, which would cause a considerable impact on the structure of sesame proteins, changing their sensitization capacity and detectability. In the review, the molecular structure properties, and immunological characteristics of the sesame allergens were described. Meanwhile, the influence of food processing techniques on sesame proteins and the relevant detection techniques used for the sesame allergens quantification are also emphasized critically. Hopefully, this review could provide valuable insight into the development and management for the new "Big Eight" sesame allergen in food industry.

Knowledge, Attitudes, and Practices toward Antimicrobial Resistance among Young Italian Nurses and Students: A Multicenter, Cross-Sectional Study

Background: Nurses play a pivotal role in combating antimicrobial resistance (AMR). However, the success of local and national AMR containment efforts hinges on the knowledge, attitude, and practice (KAP) of nursing staff and undergraduate students. Objectives: This study aims to explore the determinants of nurses' KAP regarding AMR, offering insights to control the emergence and spread of drug-resistant pathogens. Methods: This cross-sectional, multicenter survey involving Italian nurses, nursing students, and healthcare professionals was conducted administering an anonymous online questionnaire focusing on AMR. The median score of 12 was taken as the cutoff for "good KAP." The association between study variables and good KAP was assessed using chi-square or t-tests, followed by multivariable logistic regression analysis for statistically significant (p < 0.05) variables. Findings: Among 848 participants, 61.9% (n = 525) were students, and 39.6% (n = 336) scored as having "low KAP." High KAP was associated with being female and studying AMR independently. Conversely, living in southern Italy and receiving AMR training from pharmaceutical companies were associated with low KAP. Conclusions: Among Italian nurses, AMR awareness relies on those who have studied AMR as self-taught and is affected by gender and region. Italian universities lack in lectures on AMR management, and much needs to be done to improve awareness of antimicrobial stewardship among nonmedical health workers.

Investigation of gyrA and parC mutations and the prevalence of plasmid-mediated quinolone resistance genes in Klebsiella pneumoniae clinical isolates

BACKGROUND

The emergence of fluoroquinolone resistance in clinical isolates of Klebsiella pneumoniae is a growing concern. To investigate the mechanisms behind this resistance, we studied a total of 215 K. pneumoniae isolates from hospitals in Bushehr province, Iran, collected between 2017 and 2019. Antimicrobial susceptibility test for fluoroquinolones was determined. The presence of plasmid mediated quinolone resistance (PMQR) and mutations in quinolone resistance-determining region (QRDR) of gyrA and parC genes in ciprofloxacin-resistant K. pneumoniae isolates were identified by PCR and sequencing.

RESULTS

Out of 215 K. pneumoniae isolates, 40 were resistant to ciprofloxacin as determined by E-test method. PCR analysis revealed that among these ciprofloxacin-resistant isolates, 13 (32.5%), 7 (17.5%), 40 (100%), and 25 (62.5%) isolates harbored qnrB, qnrS, oqxA and aac(6')-Ib-cr genes, respectively. Mutation analysis of gyrA and parC genes showed that 35 (87.5%) and 34 (85%) of the ciprofloxacin-resistant isolates had mutations in these genes, respectively. The most frequent mutations were observed in codon 83 of gyrA and codon 80 of parC gene. Single gyrA substitution, Ser83→ Ile and Asp87→Gly, and double substitutions, Ser83→Phe plus Asp87→Ala, Ser83→Tyr plus Asp87→Ala, Ser83→Ile plus Asp87→Tyr, Ser83→Phe plus Asp87→Asn and Ser83→Ile plus Asp87→Gly were detected. In addition, Ser80→Ile and Glu84→Lys single substitution were found in parC gene.

CONCLUSIONS

Our results indicated that 90% of isolates have at least one mutation in QRDR of gyrA orparC genes, thus the frequency of mutations was very significant and alarming in our region.

The effects of monoculture and intercropping on photosynthesis performance correlated with growth of garlic and perennial ryegrass response to different heavy metals

BACKGROUND

The potential of phytoremediation using garlic monoculture (MC) and intercropping (IC) system with perennial ryegrass to enhance the uptake of cadmium (Cd), chromium (Cr), and lead (Pb) were investigated.

RESULTS

Positive correlations were found between MC and IC systems, with varying biomass. Production of perennial ryegrass was affected differently depending on the type of toxic metal present in the soil. Root growth inhibition was more affected than shoot growth inhibition. The total biomass of shoot and root in IC was higher than MC, increasing approximately 3.7 and 2.9 fold compared to MC, attributed to advantages in root IC crop systems. Photosystem II efficiency showed less sensitivity to metal toxicity compared to the control, with a decrease between 10.07-12.03%. Among gas exchange parameters, only Cr significantly affected physiological responses by reducing transpiration by 69.24%, likely due to leaf chlorosis and necrosis.

CONCLUSION

This study exhibited the potential of garlic MC and IC with perennial ryegrass in phytoremediation. Although the different metals affect plant growth differently, IC showed advantages over MC in term biomass production.

Synergistic Mechanisms of Selected Polyphenols in Overcoming Chemoresistance and Enhancing Chemosensitivity in Colorectal Cancer

Colorectal cancer (CRC) is a leading cause of cancer deaths worldwide. Despite significant advances in medical treatment, chemotherapy as monotherapy can lead to substantial side effects and chemoresistance. This underscores the need for therapeutic approaches that are not only pharmacologically safe but also modulate multiple potent signaling pathways and sensitize cancer cells to overcome resistance to standard drugs. In recent years, scientists have been searching for natural compounds that can be used as chemosensitizers in addition to conventional medications for the synergistic treatment of CRC. Polyphenols represent a diverse group of natural compounds that can target multiple signaling pathways in cancer cells to induce anti-cancer effects. Additionally, polyphenols have been shown to work synergistically with chemotherapeutics and other natural compounds in cancer cells. This review aims to provide a comprehensive insight into the synergistic mechanisms of selected polyphenols as chemosensitizers in CRC cells. Further research and clinical trials are warranted to fully harness the synergistic mechanisms of selected polyphenols combined with chemotherapy or natural compounds in improving cancer treatment outcomes.

An Analysis of Inpatient Satisfaction with Trust-related Factors of Public Secondary and Tertiary Hospitals in China

BACKGROUND AND OBJECTIVES

Patient satisfaction surveys are implemented as an essential quality improvement tool in healthcare markets. This study investigates patient satisfaction in public secondary and tertiary hospitals and identifies factors contributing to inpatient satisfaction, particularly trust-related factors, to eventually improve the quality of care in the healthcare system.

METHODS

A population-based cross-sectional survey was conducted between February and April 2021 in 31 Chinese provinces. Telephone interviews with computer assistance were used to gather data. Spearman Rank Correlation was used to analyze satisfaction with hospitalization services between secondary and tertiary hospitals. Multiple Linear Regression was used to determine the influencing factors of overall patient satisfaction.

RESULTS

Inpatients reported more satisfaction with inpatient care when doctors treated them respectfully (p < 0.01). Inpatients with higher self-identified social class reported higher satisfaction (p < 0.01). Inpatients who trust in most people in society (p < 0.01) and trust in the Chinese healthcare system (p < 0.01) reported higher satisfaction. Female inpatients reported higher overall satisfaction (p < 0.01).

CONCLUSIONS

The study of Chinese inpatients in secondary and tertiary hospitals highlighted the importance of respect from doctors, their self-identified social class, and their trust in influencing satisfaction during their hospital stay and called for additional research into policy measures.

Emerging contaminants: A One Health perspective

Environmental pollution is escalating due to rapid global development that often prioritizes human needs over planetary health. Despite global efforts to mitigate legacy pollutants, the continuous introduction of new substances remains a major threat to both people and the planet. In response, global initiatives are focusing on risk assessment and regulation of emerging contaminants, as demonstrated by the ongoing efforts to establish the UN's Intergovernmental Science-Policy Panel on Chemicals, Waste, and Pollution Prevention. This review identifies the sources and impacts of emerging contaminants on planetary health, emphasizing the importance of adopting a One Health approach. Strategies for monitoring and addressing these pollutants are discussed, underscoring the need for robust and socially equitable environmental policies at both regional and international levels. Urgent actions are needed to transition toward sustainable pollution management practices to safeguard our planet for future generations.

The Role of Fenugreek in the Management of Type 2 Diabetes

The number of people diagnosed with type 2 diabetes is on the increase worldwide. Of growing concern, the prevalence of type 2 diabetes in children and youths is increasing rapidly and mirrors the increasing burden of childhood obesity. There are many risk factors associated with the condition; some are due to lifestyle, but many are beyond our control, such as genetics. There is an urgent need to develop better therapeutics for the prevention and management of this complex condition since current medications often cause unwanted side effects, and poorly managed diabetes can result in the onset of related comorbidities. Naturally derived compounds have gained momentum for preventing and managing several complex conditions, including type 2 diabetes. Here, we provide an update on the benefits and limitations of fenugreek and its components as a therapeutic for type 2 diabetes, including its bioavailability and interaction with the microbiome.

Thai traditional medicines reduce CD147 levels in lung cells: Potential therapeutic candidates for cancers, inflammations, and COVID-19

ETHNOPHARMACOLOGICAL RELEVANCE

The cluster of differentiation 147 (CD147) is identified as the signaling protein relevant importantly in various cancers, inflammations, and coronavirus disease 2019 (COVID-19) via interacting with extracellular cyclophilin A (CypA). The reduction of CD147 levels inhibits the progression of CD147-associated diseases. Thai traditional medicines (TTMs): Keaw-hom (KH), Um-ma-ruek-ka-wa-tee (UM), Chan-ta-lee-la (CT), and Ha-rak (HR) have been used as anti-pyretic and anti-respiratory syndromes caused from various conditions including cancers, inflammations, and infections. Thus, these medicines would play a crucial role in the reduction of CD147 levels.

AIM OF THE STUDY

This article aimed to investigate the effects of KH, UM, CT, and HR for reducing the CD147 levels through in vitro study. Additionally, in silico study was employed to screen the active compounds reflexing the reduction of CD147 levels.

MATERIALS AND METHODS

The immunofluorescent technique was used to evaluate the reduction of CD147 levels in human lung epithelial cells (BEAS-2B) stimulated with CypA for eight extracts of KH, UM, CT, and HR obtained from water decoction (D) and 70% ethanol maceration (M) including, KHD, UMD, CTD, HRD, KHM, UMM, CTM, and HRM.

RESULTS

UM extracts showed the most efficiency for reduction of CD147 levels in the cytoplasm and perinuclear of BEAS-2B cells stimulated with CypA. Phenolic compounds composing polyphenols, polyphenol sugars, and flavonoids were identified as the major chemical components of UMD and UMM. Further, molecular docking calculations identified polyphenol sugars as CypA inhibitors.

CONCLUSIONS

UMD and UMM are potential for reduction of CD147 levels which provide a useful information for further development of UM as potential therapeutic candidates for CD147-associated diseases such as cancers, inflammations, and COVID-19.

The occurrence of aflatoxins and labelling compliance of locally produced za'atar mix products

Za'atar mix products are mainly composed of the dried and ground leaves and/or blossoms of wild and cultivated plant species (Origanum, Thymbra, Thymus, and Satureja) with the addition of condiments. The aim of this study was to evaluate the occurrence of aflatoxins, chemical composition (carbohydrates, fibre, fat, protein, moisture, ash, and acid contents), mineral content (Na, Ca, and K), and colour traits (L*a*b*) in relation to food label and food standards compliance. Measured and labelled fat content did not agree for approximately 91% of the samples. There was also no agreement between the measured and labelled fibre contents. The total content of aflatoxins in the tested samples ranged from 2 to 63.7 ng g-1. Eleven (69%) of the 16 analysed products had total aflatoxins higher than the maximum permitted limit of the European Commission. The KAS and LAZ products had significantly lighter colour (the highest L* values), while the ALAQ product had the darkest colour (lowest L* value). The range of sodium content in the tested products was 105.1-1425.3 mg/100 g. In conclusion, za'atar mix products that are available in local markets do not have accurate nutritional labelling information, and the occurrence of aflatoxins was very high. Further studies are needed to evaluate the reasons for these quality defects.

The hidden dangers lurking at home: Unveiling the prevalence of leftover antibiotics and its associated factors among Lebanese households

Background

Antimicrobial Resistance (AMR) is a major global concern. Irrational use of antibiotics including self-medication (SM) with leftovers without a medical prescription can be a leading cause. This study aimed to investigate the prevalence and related factors of leftover antibiotics (LA) in Lebanese households.

Study design

A cross-sectional study of the Lebanese population was conducted between March and October 2022.

Methods

Through random proportional stratified sampling, a total of 494 families participated in this study. Data collection was carried out through phone calls using a comprehensive and reviewed questionnaire. The data was then analyzed using SPSS version 26. Logistic regression was utilized to identify the factors associated with LA, with the presence of LA in households as the dependent variable and other factors such as age, region of residence, and presence of elderly individuals at home as the independent variables.

Results

Among selected households, 118 households (23.89%) had LA. The most common type of antibiotic found was penicillin (59.84%). Most of the LA were in the form of tablets and capsules (94%) with valid expiration dates (87%). Antibiotics were mainly prescribed by doctors (61%), and the main reason for prescribing was acute respiratory tract infections (47.46%). SM was reported by 42.37% of the families with LA. A family with elderly patients (p = 0.002; OR = 2.23; 95% CI = 1.33-3.73) and those residing in Mount Lebanon (p = 0.019; OR = 2.28; 95% CI = 1.14-4.56) had significantly higher odds of having LA.

Conclusion

Leftover antibiotics were found in nearly a quarter of the addressed Lebanese families. Therefore, public educational campaigns should be launched to limit injudicious antibiotic use including SM, and to promote proper disposal of any leftovers. It is also crucial to adopt the One Health approach by developing national programs for the safe disposal of LA and implementing regulations to restrict the distribution of antibiotics in pharmacies without a prescription.

Vitamin D and vitamin K1 as novel inhibitors of biofilm in Gram-negative bacteria

BACKGROUND

The persistent surge in antimicrobial resistance represents a global disaster. The initial attachment and maturation of microbial biofilms are intimately related to antimicrobial resistance, which in turn exacerbates the challenge of eradicating bacterial infections. Consequently, there is a pressing need for novel therapies to be employed either independently or as adjuvants to diminish bacterial virulence and pathogenicity. In this context, we propose a novel approach focusing on vitamin D and vitamin K1 as potential antibiofilm agents that target Gram-negative bacteria which are hazardous to human health.

RESULTS

Out of 130 Gram-negative bacterial isolates, 117 were confirmed to be A. baumannii (21 isolates, 17.9%), K. pneumoniae (40 isolates, 34.2%) and P. aeruginosa (56 isolates, 47.9%). The majority of the isolates were obtained from blood and wound specimens (27.4% each). Most of the isolates exhibited high resistance rates to β-lactams (60.7-100%), ciprofloxacin (62.5-100%), amikacin (53.6-76.2%) and gentamicin (65-71.4%). Approximately 93.2% of the isolates were biofilm producers, with 6.8% categorized as weak, 42.7% as moderate, and 50.4% as strong biofilm producers. The minimum inhibitory concentrations (MICs) of vitamin D and vitamin K1 were 625-1250 µg mL-1 and 2500-5000 µg mL-1, respectively, against A. baumannii (A5, A20 and A21), K. pneumoniae (K25, K27 and K28), and P. aeruginosa (P8, P16, P24 and P27) clinical isolates and standard strains A. baumannii (ATCC 19606 and ATCC 17978), K. pneumoniae (ATCC 51503) and P. aeruginosa PAO1 and PAO14. Both vitamins significantly decreased bacterial attachment and significantly eradicated mature biofilms developed by the selected standard and clinical Gram-negative isolates. The anti-biofilm effects of both supplements were confirmed by a notable decrease in the relative expression of the biofilm-encoding genes cusD, bssS and pelA in A. baumannii A5, K. pneumoniae K28 and P. aeruginosa P16, respectively.

CONCLUSION

This study highlights the anti-biofilm activity of vitamins D and K1 against the tested Gram-negative strains, which emphasizes the potential of these vitamins for use as adjuvant therapies to increase the efficacy of treatment for infections caused by multidrug-resistant (MDR) strains and biofilm-forming phenotypes. However, further validation through in vivo studies is needed to confirm these promising results.

Developing active and intelligent biodegradable packaging from food waste and byproducts: A review of sources, properties, film production methods, and their application in food preservation

Food waste and byproducts (FWBP) are a global issue impacting economies, resources, and health. Recycling and utilizing these wastes, due to processing and economic constraints, face various challenges. However, valuable components in food waste inspire efficient solutions like active intelligent packaging. Though research on this is booming, its material selectivity, effectiveness, and commercial viability require further analysis. This paper categorizes FWBP and explores their potential for producing packaging from both animal and plant perspectives. In addition, the preparation/fabrication methods of these films/coatings have also been summarized comprehensively, focusing on the advantages and disadvantages of these methods and their commercial adaptability. Finally, the functions of these films/coatings and their ultimate performance in protecting food (meat, dairy products, fruits, and vegetables) are also reviewed systematically. FWBP provide a variety of methods for the application of edible films, including being made into coatings, films, and fibers for food preservation, or extracting active substances directly or indirectly from them (in the form of encapsulation) and adding them to packaging to endow them with functions such as barrier, antibacterial, antioxidant, and pH response. In addition, the casting method is the most commonly used method for producing edible films, but more film production methods (extrusion, electrospinning, 3D printing) need to be tried to make up for the shortcomings of the current methods. Finally, researchers need to conduct more in-depth research on various active compounds from FWBP to achieve better application effects and commercial adaptability.

Enhancing the Bioavailability of Resveratrol: Combine It, Derivatize It, or Encapsulate It?

Overcoming the limited bioavailability and extensive metabolism of effective in vitro drugs remains a challenge that limits the translation of promising drugs into clinical trials. Resveratrol, despite its well-reported therapeutic benefits, is not metabolically stable and thus has not been utilized as an effective clinical drug. This is because it needs to be consumed in large amounts to overcome the burdens of bioavailability and conversion into less effective metabolites. Herein, we summarize the more relevant approaches to modify resveratrol, aiming to increase its biological and therapeutic efficacy. We discuss combination therapies, derivatization, and the use of resveratrol nanoparticles. Interestingly, the combination of resveratrol with established chemotherapeutic drugs has shown promising therapeutic effects on colon cancer (with oxaliplatin), liver cancer (with cisplatin, 5-FU), and gastric cancer (with doxorubicin). On the other hand, derivatizing resveratrol, including hydroxylation, amination, amidation, imidation, methoxylation, prenylation, halogenation, glycosylation, and oligomerization, differentially modifies its bioavailability and could be used for preferential therapeutic outcomes. Moreover, the encapsulation of resveratrol allows its trapping within different forms of shells for targeted therapy. Depending on the nanoparticle used, it can enhance its solubility and absorption, increasing its bioavailability and efficacy. These include polymers, metals, solid lipids, and other nanoparticles that have shown promising preclinical results, adding more "hype" to the research on resveratrol. This review provides a platform to compare the different approaches to allow directed research into better treatment options with resveratrol.

Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature

Antimicrobial resistance is a global public health crisis. Effective antimicrobial stewardship requires an understanding of the factors and context that contribute to inappropriate use of antimicrobials. The goal of this qualitative systematic review was to synthesize themes across levels of the social ecological framework that drive inappropriate use of antimicrobials in South Asia. In September 2023, we conducted a systematic search using the electronic databases PubMed and Embase. Search terms, identified a priori, were related to research methods, topic, and geographic location. We identified 165 articles from the initial search and 8 upon reference review (n = 173); after removing duplicates and preprints (n = 12) and excluding those that did not meet eligibility criteria (n = 115), 46 articles were included in the review. We assessed methodological quality using the qualitative Critical Appraisal Skills Program checklist. The studies represented 6 countries in South Asia, and included data from patients, health care providers, community members, and policy makers. For each manuscript, we wrote a summary memo to extract the factors that impede antimicrobial stewardship. We coded memos using NVivo software; codes were organized by levels of the social ecological framework. Barriers were identified at multiple levels including the patient (self-treatment with antimicrobials; perceived value of antimicrobials), the provider (antimicrobials as a universal therapy; gaps in knowledge and skills; financial or reputational incentives), the clinical setting (lack of resources; poor regulation of the facility), the community (access to formal health care; informal drug vendors; social norms), and policy (absence of a regulatory framework; poor implementation of existing policies). This study is the first to succinctly identify a range of norms, behaviors, and policy contexts driving inappropriate use of antimicrobials in South Asia, emphasizing the importance of working across multiple sectors to design and implement approaches specific to the region.

Toxicity and bioremediation of the lead: a critical review

Lead is a naturally occurring, bluish-gray metal that is found in small quantities in the earth's crust. The existing literature demonstrates that non-biodegradable character and continuous use results in accumulation of lead concentration in the environment and causes various ill effects such as neurotoxicity, change in psychological and behavioral development of different organisms. Nowadays the most effective technique in the revival of the environment is bioremediation and it is environmentally friendly and cost-effective. Bacterial strains such as Oceanobacillus profundus and Lactobacillus acidophilus ATCC4356 have the ability to reduce lead 97% and 73.9%, respectively. Similarly some species of algae and fungal strains also showed lead removal efficiency as 74% (spirulina), 97.1% (Chlorella kessleri), 95.5% (Penicillium janthinillum) and 86% (Aspergillus flavus). Biodegradation of lead by various microbes would be the most efficient and sustainable approach. This review focuses on toxicity, fate of lead in the environment and its microbial degradation.

Human biomonitoring of trace metals from different altitudinal settings of Pakistan

Human biomonitoring of toxic trace elements is of critical importance for public health protection. The current study aims to assess the levels of selected trace metals (Cd, Co, Cr, Cu, Mn, Ni, Pb, and Zn) into paired human nail and hair samples (n = 180 each) from different altitudinal setting along the Indus River, and which were measured by using inductively coupled plasma mass spectrometry (ICP-MS). The human samples (hair and nail) were collected from four different ecological zones of Pakistan which include frozen mountain zone (FMZ), wet mountain zone (WMZ), riverine delta zone (RDZ), and low-lying southern areas (LLZ). Our results showed the following occurrence trends into studied hair samples: higher values (ppm) of Zn (281), Co (0.136), and Mn (5.65) at FMZ; Cr (1.37), Mn (7.83), and Ni (1.22) at WMZ; Co (0.15), Mn (11.89), and Ni (0.99) at RDZ; and Mn (8.99) and Ni (0.90) at LLZ. While in the case of nails, the levels (ppm) of Mn (9.91) at FMZ and Mn (9.38, 24.1, and 12.5), Cr (1.84, 3.87, and 2.33), and Ni (10.69, 8.89, and 12.6) at WMZ, RDZ and LLZ, respectively, showed higher concentration. In general, among the studied trace elements, Mn and Ni in hair/nail samples were consistently higher and exceeded the WHO threshold/published reference values in most of the studied samples (> 50-60%) throughout the Indus basin. Similarly, hair/nail Pb values were also higher in few cases (2-10%) at all studied zones and exceeded the WHO threshold/published reference values. Our area-wise comparisons of studied metals exhibited altitudinal trends for Cd, Cr, Zn, and Mn (p < 0.05), and surprisingly, the values were increasing from south to north (at higher altitudes) and indicative of geogenic sources of the studied toxic elements, except Mn, which was higher at lower floodplain areas. Estimated daily intake (EDI) values showed that food and drinking water had the highest contribution towards Zn, Cu, Mn, and Ni and accumulation at all studied zones. Whereas, dust also acts as the main exposure route for Mn, Co, Cr, and Cd followed by the food, and water.

Current perspective in research and industrial applications of microbial cellulases

The natural interactions between various bacteria, fungi, and other cellulolytic microorganisms destroy lignocellulosic polymers. The efficacy of this process is determined by the combined action of three main enzymes: endoglucanases, exo-glucanases, and β-glucosidase. The enzyme attacks the polymeric structure's β-1,4-linkages during the cellulose breakdown reaction. This mechanism is crucial for the environment as it recycles cellulose in the biosphere. However, there are problems with enzymatic cellulose breakdown, including complex cellulase structure, insufficient degradation efficacy, high production costs, and post-translational alterations, many of which are closely related to certain unidentified cellulase properties. These issues impede the practical use of cellulases. A developing area of research is the application of this similar paradigm for industrial objectives. Cellulase enzyme exhibits greater promise in many critical industries, including biofuel manufacture, textile smoothing and finishing, paper and pulp manufacturing, and farming. However, the study on cellulolytic enzymes must move forward in various directions, including increasing the activity of cellulase as well as designing peptides to give biocatalysts their desired attributes. This manuscript includes an overview of current research on different sources of cellulases, their production, and biochemical characterization.

Effect of fenugreek and flaxseed polysaccharide-based edible coatings on the quality attributes and shelf life of apple fruit during storage

The present study was designed to explore the potential of fenugreek and flaxseed polysaccharide-based edible coatings to enhance the postharvest storage life of apple fruit. The experimental plan involved the preparation of five different coating formulations, which were subsequently applied to the fruit. The coated fruit was then stored at a temperature of 25 ± 2°C for a duration of 35 days. The effects of these coatings on physicochemical and biochemical attributes (weight loss, firmness, acidity, pH, sugar content, antioxidant activity, microbial growth, and sensory properties) of coated and uncoated samples were evaluated at regular intervals: 0, 7, 14, 21, 28, and 35 days of storage. The experimental results revealed a significant difference (p ≤ .05) in the physicochemical parameters of uncoated and coated apple at different storage times. The coated apple fruits showed significantly (p ≤ .05) lower weight loss, pH, total sugars, total soluble solids, and maximum retention of ascorbic acid, firmness, acidity, and antioxidant contents, leading to enhanced organoleptic properties. The application of edible coatings extended the shelf-life of the apples by inhibiting microbiological spoilage without substantial impact on sensory and nutritional properties. Based on these results, it is concluded that the edible coating formulation labeled T 1 (containing 2.5 g fenugreek polysaccharide and 1.5 g flax polysaccharide) effectively preserved the valuable physicochemical and organoleptic characteristics of the apple fruit throughout the storage period.

Innovative applications of whey protein for sustainable dairy industry: Environmental and technological perspectives-A comprehensive review

Industrial waste management is critical to maintaining environmental sustainability. The dairy industry (DI), as one of the major consumers of freshwater, generates substantial whey dairy effluent, which is notably rich in organic matter and thus a significant pollutant. The effluent represents environmental risks due to its high biological and chemical oxygen demands. Today, stringent government regulations, environmental laws, and heightened consumer health awareness are compelling industries to responsibly manage and reuse whey waste. Therefore, this study investigates sustainable solutions for efficiently utilizing DI waste. Employing a systematic review approach, the research reveals that innovative technologies enable the creation of renewable, high-quality, value-added food products from dairy byproducts. These innovations offer promising sustainable waste management strategies for the dairy sector, aligning with economic interests. The main objectives of the study deal with, (a) assessing the environmental impact of dairy sector waste, (b) exploring the multifaceted nutritional and health benefits inherent in cheese whey, and (c) investigating diverse biotechnological approaches to fashion value-added, eco-friendly dairy whey-based products for potential integration into various food products, and thus fostering economic sustainability. Finally, the implications of this work span theoretical considerations, practical applications, and outline future research pathways crucial for advancing the sustainable management of dairy waste.

A novel approach to insulin delivery via oral route: Milk fat globule membrane derived liposomes as a delivery vehicle

The current research endeavor seeks to unlock the potential of orally administered insulin formulations by utilizing liposomes derived from the fat globule membrane (MFGM) of camel milk as carriers for insulin. This pursuit emerges as a result of the recognized limitations of subcutaneous insulin therapy. The liposomes were meticulously created using the thin film hydration method, followed by comprehensive chemical and morphological analyses. Additionally, comprehensive safety assessments were carried out in vitro and in vivo, revealing significant findings. The Fourier-transform infrared (FTIR) spectrum confirmed the presence of insulin within the liposomes, demonstrating changes in their size and charge. The in vitro cytotoxicity analysis, performed on HEK-293 cell lines through the MTT assay, yielded results indicating a cell viability of over 90%. In the in vivo investigation, diabetic rats induced by STZ were utilized to evaluate the effects of the liposomes, revealing substantial reductions in blood glucose levels, bilirubin, alkaline phosphatase (ALP), albumin, and alanine aminotransferase (ALT) levels. Hepatic histopathological assessments showed signs of recovery across all treatment groups, with no observable microscopic changes in renal tissue. This investigation highlights the significant hypoglycemic effects observed in insulin-loaded liposomes derived from MFGM obtained from camel milk when administered orally.

Antibiotics in semen extenders - a multiplicity of paradoxes

Addition of antibiotics to semen extenders was taken for granted for many years, from the time that commercial artificial insemination in livestock first began many decades ago. However, there is now a growing realisation that this non-therapeutic utilisation of antibacterial agents is contrary to current recommendations for prudent use that medical and veterinary professionals are advised to follow. Furthermore, antibiotics are not benign, having negative effects on sperm samples, the inseminated female, personnel and potentially the environment. The purpose of this review is three-fold: to highlight the fact that antibiotics are used in semen extenders, with the result that considerable amounts are used globally in animal breeding, to review recent studies on the negative aspects of using antibiotics for this purpose, and to look at possible alternatives. Recent changes in the legislation regarding semen extenders occurred in some, but not all, countries, leaving question marks for semen producers as to whether antibiotics should be added to semen extenders or not.

Antibiotic disposal challenges in India: investigating causes and effects

Antibiotic resistance has become a global problem and India emerges as a key battlefield in the fight against it. While inappropriate use of antibiotics is well known, the review article deliberates a less recognized yet equally perilous facet of the crisis i.e. improper antibiotic disposal. An investigation of the sources of antibiotic pollution in Indian water bodies identifies discharge of pharmaceutical effluents, hospital waste, and agricultural runoff as major contributing factors. Furthermore, it discusses the repercussions of antibiotic pollution including those relating to human health, aquatic ecosystems, and antibiotic resistance. Reviewing the causes and consequences of improper antibiotic disposal practices emphasizes the necessity of rethinking antibiotic waste management practices. The review highlights the need for stringent rules and increased awareness, while also discussing the emerging technologies and strategies to mitigate the risks of antibiotic disposal in India.

Halophilic filamentous fungi and their enzymes: Potential biotechnological applications

Recently, interest in the study of microorganisms growing under extreme conditions, particularly halophiles, has increased due to their potential use in industrial processes. Halophiles are the class of microorganisms that grow optimally at high NaCl concentrations and are capable of producing halophilic enzymes capable of catalyzing reactions under harsh conditions. So far, fungi are the least studied halophilic microorganisms, even though they have been shown to counteract these extreme conditions by producing secondary metabolites with very interesting properties. This review highlights mechanisms that allow halophilic fungi to adapt high salinity and the specificity of their enzymes to a spectrum of action in industrial and environmental applications. The peculiarities of these enzymes justify the urgent need to apply green alternative compounds in industries.

Functional characterisation of a new halotolerant seawater active glycoside hydrolase family 6 cellobiohydrolase from a salt marsh

Realising a fully circular bioeconomy requires the valorisation of lignocellulosic biomass. Cellulose is the most attractive component of lignocellulose but depolymerisation is inefficient, expensive and resource intensive requiring substantial volumes of potable water. Seawater is an attractive prospective replacement, however seawater tolerant enzymes are required for the development of seawater-based biorefineries. Here, we report a halophilic cellobiohydrolase SMECel6A, identified and isolated from a salt marsh meta-exo-proteome dataset with high sequence divergence to previously characterised cellobiohydrolases. SMECel6A contains a glycoside hydrolase family 6 (GH6) domain and a carbohydrate binding module family 2 (CBM2) domain. Characterisation of recombinant SMECel6A revealed SMECel6A to be active upon crystalline and amorphous cellulose. Mono- and oligosaccharide product profiles revealed cellobiose as the major hydrolysis product confirming SMECel6A as a cellobiohydrolase. We show SMECel6A to be halophilic with optimal activity achieved in 0.5X seawater displaying 80.6 ± 6.93% activity in 1 × seawater. Structural predictions revealed similarity to a characterised halophilic cellobiohydrolase despite sharing only 57% sequence identity. Sequential thermocycling revealed SMECel6A had the ability to partially reversibly denature exclusively in seawater retaining significant activity. Our study confirms that salt marsh ecosystems harbour enzymes with attractive traits with biotechnological potential for implementation in ionic solution based bioprocessing systems.

Assessment of global antimicrobial resistance campaigns conducted to improve public awareness and antimicrobial use behaviours: a rapid systematic review

INTRODUCTION

Public health campaigns with a well-defined outcome behaviour have been shown to successfully alter behaviour. However, the complex nature of antimicrobial resistance (AMR) creates challenges when evaluating campaigns aimed at raising awareness and changing behaviour.

AIMS

To determine what campaigns have been conducted and which reported being effective at improving awareness of antimicrobial resistance and changing behaviour around antimicrobial use in members of the public. It also sought to determine the outcome measures studies have used to assess campaign effectiveness.

METHODS

A systematic search of Ovid MEDLINE and Embase, was conducted in October 2022 using a predefined search strategy. Studies which were published between 2010 and September 2022 that outlined a campaign or invention aimed at the public and focusing on AMR or antibiotic usage were eligible for inclusion and studies which solely targeted healthcare professionals (HCP) were excluded.

RESULTS

Literature searches retrieved 6961 results. De-duplication and screening removed 6925 articles, five articles from grey literature and reference screening were included, giving a total of 41 studies and 30 unique interventions. There was a distribution of campaigns globally with the majority run in Europe (n = 15) with most campaigns were conducted nationally (n = 14). Campaigns tended to focus on adult members of the public (n = 14) or targeted resources towards both the public and HCPs (n = 13) and predominately assessed changes in knowledge of and/or attitudes towards AMR (n = 16). Campaigns where an improvement was seen in their primary outcome measure tended to use mass media to disseminate information, targeted messaging towards a specific infection, and including the use of HCP-patient interactions.

DISCUSSION

This review provides some evidence that campaigns can significantly improve outcome measures relating to AMR and antibiotic usage. Despite a lack of homogeneity between studies some common themes emerged between campaigns reported as being effective. However, the frequent use of observational study designs makes it difficult to establish causation between the campaign and changes seen in the studies outcome measures. It is important that clear evaluation processes are embedded as part of the design process for future campaigns; a campaign evaluation framework for use by campaign developers may facilitate this.

Fungal bioremediation approaches for the removal of toxic pollutants: Mechanistic understanding for biorefinery applications

Pollution is a global menace that poses harmful effects on all the living ecosystems and to the Earth. As years pass by, the available and the looming rate of pollutants increases at a faster rate. Although many treatments and processing strategies are waged for treating such pollutants, the by-products and the wastes or drain off generated by these treatments further engages in the emission of hazardous waste. Innovative and long-lasting solutions are required to address the urgent global issue of hazardous pollutant remediation from contaminated environments. Myco-remediation is a top-down green and eco-friendly tool for pollution management. It is a cost-effective and safer practice of converting pernicious substances into non-toxic forms by the use of fungi. But these pollutants can be transformed into useable products along with multiple benefits for the environment such as sequestration of carbon emissions and also to generate high valuable bioactive materials that fits as a sustainable economic model. The current study has examined the possible applications of fungi in biorefineries and their critical role in the transformation and detoxification of pollutants. The paper offers important insights into using fungal bioremediation for both economically and environmentally sound solutions in the domain of biorefinery applications by combining recent research findings.