Phenotypic detection of methicillin resistance, biofilm production, and inducible clindamycin resistance in Staphylococcus aureus clinical isolates in Kathmandu, Nepal

INTRODUCTION

Methicillin resistance, inducible clindamycin resistance (ICR), biofilm production, and increased minimum inhibitory concentration (MIC) of vancomycin in Staphylococcus aureus are major causes of antibiotic treatment failure and increased morbidity and mortality. The surveillance of such isolates and the study of their antimicrobial pattern are essential in managing the infections caused by these isolates. This study aimed to determine methicillin resistance, biofilm production, and ICR in S. aureus isolates from a tertiary care hospital in Kathmandu, Nepal.

MATERIALS AND METHODS

A total of 217 S. aureus isolated from different samples were processed following standard laboratory procedures. Antibiotic susceptibility testing was performed by the Kirby-Bauer disk diffusion technique. Methicillin-resistant S. aureus (MRSA) were identified by the cefoxitin disk diffusion test, and biofilm producers were examined using the microtiter plate technique. D-test and E-test were performed to determine inducible clindamycin resistance and minimum inhibitory concentration of vancomycin, respectively.

RESULTS

Among the 217 S. aureus isolates, 78.3% were multidrug-resistant (MDR), 47.0% were MRSA, 62.2% were biofilm producers, and 50.7% showed ICR. All MRSA isolates exhibited MIC levels of vancomycin within the susceptible range. Biofilm producers and MRSA isolates showed elevated antimicrobial resistance. MRSA was significantly associated with MDR. Biofilm-producing and multidrug-resistant MRSA isolates showed significantly higher MIC levels of vancomycin (p = 0.0013 and < 0.0001, respectively), while ICR was significantly higher in MDR (p = 0.0001) isolates.

CONCLUSION

High multidrug resistance, MRSA, and ICR in this study call for routine evaluation of antibiotic susceptibility patterns of S. aureus. Vancomycin can be used to treat serious staphylococcal infections. Clindamycin should be prescribed only after performing the D-test. Drugs like teicoplanin, chloramphenicol, doxycycline, amikacin, and levofloxacin can treat MRSA infections.

Electrospun PVDF-TrFE/MXene Nanofiber Mat-Based Triboelectric Nanogenerator for Smart Home Appliances

Understanding of the triboelectric charge accumulation from the view of microcapacitor formation plays a critical role in boosting the output performance of the triboelectric nanogenerator (TENG). Here, an electrospun nanofiber-based TENG (EN-TENG) using a poly(vinylidene fluoride-trifluoroethylene) (PVDF-TrFE)/MXene nanocomposite material with superior dielectric constant and high surface charge density is reported. The influence of dielectric properties on the output performance of the EN-TENG is investigated theoretically and experimentally. The fabricated EN-TENG exhibited a maximum power density of 4.02 W/m² at a matching external load resistance of 4 MΩ. The PVDF-TrFE/MXene nanocomposite improved the output performance of the EN-TENG fourfold. The EN-TENG successfully powered an electronic stopwatch and thermo-hygrometer by harvesting energy from human finger tapping. Moreover, it was utilized in smart home applications as a self-powered switch for controlling electrical home appliances, including fire alarms, fans, and smart doors. This work presents an effective and innovative approach toward self-powered systems, human-machine interfaces, and smart home applications.

The effect of feeding adequate or deficient vitamin B6 or folic acid to breeders on methionine metabolism in 18-day-old chick embryos

Three isotopic tracers ([2,3,3-²H₃]-L-serine, [²H₁₁]-L-betaine, and [1-¹³C]-L-methionine) were administered by amnion injection into 18-day-old chick embryos to investigate the kinetics of methionine metabolism. The embryos utilized were from eggs collected from 34-week-old Cobb 500 broiler breeders that were fed either a control diet containing folic acid (1.25 mg/kg diet) and pyridoxine HCl (5 mg/kg diet) or diets devoid of supplemental pyridoxine or folic acid. Intermediate metabolites of methionine metabolism and polyamines were analyzed in 18-day-old chick embryos. There were no differences in hepatic [²H₂] methionine or [²H₃] cysteine enrichments or in physiological concentrations of sulfur amino acids for chick embryos from breeders fed the control diet and embryos from breeders fed diets containing no pyridoxine or folic acid. Supplementation of B₆ or folic acid did not affect the production of methionine and cysteine in chick embryos. However, breeders fed the control diet with both folic acid and pyridoxine supplementation produced embryos with a two-fold reduction of hepatic homocysteine and increased spermine compared with embryos from breeders fed diets containing no supplemental pyridoxine or folic acid (P < 0.05). Hepatic S-adenosylmethionine for embryos from breeders fed no supplemental B₆ was half the concentration compared with embryos from breeders fed the control diet. Embryos from breeders fed the control diet were utilized to determine the proportion of homocysteine going through remethylation and transsulfuration and also to determine the pathway of remethylation. Sixty-five percent of the methyl groups used for homocysteine remethylation from control embryos was via the MFMT pathway. Alternatively, 61% of homocysteine from control embryos was remethylated via the MFMT and the BHMT reactions and 39% of homocysteine was catabolized to cysteine via the transsulfuration pathway. These data show that in embryos, intermediate metabolites of methionine and polyamines increase in concentration when pyridoxine levels are provided in deficient concentrations to the breeder hen. In addition, this research demonstrates that folic acid deficient embryos conserve methionine, rather than catabolize it to cysteine.

Non-cellulosic polysaccharide content in feed ingredients and ileal and total tract non-cellulosic polysaccharide digestibility in 21- and 42-day-old broilers fed diets with and without added composite enzymes

An initial study profiled non-cellulosic polysaccharide (NCP) levels in feed ingredient samples-corn, soybean meal (SBM), whole soybean, and distillers dried grains with solubles (DDGS). A separate NCP digestibility assay was performed in broilers at day 21 (grower phase) and day 42 (finisher phase) fed corn-soy based diets with and without composite enzymes (phytases, multi-carbohydrases, and proteases). Negative control (NC), NC + composite enzymes (NC+E), and positive control (PC) diets were tested. Negative control and NC + E diets were isocaloric, 3,020 kcal/kg ME at grower phase and 3,026 kcal/kg ME at finisher phase. Positive control diet was formulated to meet the Cobb standard nutrient specifications. Diets, pooled digesta, and excreta samples from all treatment diets were collected from 21- and 42-day-old birds and NCP content analyzed as soluble NCP (S-NCP) and insoluble NCP (I-NCP) fractions. Digestibility coefficient (DC) values were determined for all dietary treatments for both the feeding periods. Results from the ingredient analysis showed NCP levels of ∼7 to 10% in corn samples, ∼8 to 11% in SBM samples, ∼11 to 14% (including pectin level) in whole soybean, and ∼12 to 17% in DDGS samples, suggesting variation (P < 0.05) in NCP levels existed within ingredient samples. Digestibility assays showed that enzyme treated (NC + E) diet improved DC values at day 21 from 6 to 10 units and 6 to 9 units for ileal and total tract collection, respectively, for I-NCP fraction (P < 0.05) compared to DC values for NC or PC diets. The ileal DC values at day 42 were not different between treatment diets (∼0.6) but total tract DC values improved 9 to 11 units for broilers fed NC + E diet compared to NC or PC diets. Higher DC values for S-NCP were observed for all treatments for both feeding periods (∼0.7-ileal and ∼0.8-total tract) compared to DC values for I-NCP. Overall, the use of supplemental enzymes in corn-soy-based diets showed improvement in total NCP digestion.

Calcium particle size effects on plasma, excreta, and urinary Ca and P changes in broiler breeder hens

An experiment was conducted using non-colostomized and colostomized broiler breeder hens to determine the effects of feeding limestone of 2 different mean particle sizes (185 microns and 3490 microns) on P excretion, total P and Ca retention, and urinary P and Ca excretion during a 6-week feeding study. Additionally, changes in plasma inorganic P (iP) and ionic Ca (Ca++) and urinary excretion of P and Ca were determined in one egg laying cycle of 24 hours. One-hundred-fifty non-colostomized and 6 colostomized broiler breeder hens, 30 wk of age, were divided into 2 groups and fed broiler breeder diets supplemented with either small particle or large particle limestone. Two % acid insoluble ash (Celite) was added to the feed as a marker. Diets, excreta, and urine samples were analyzed for total P and Ca by ionic coupling plasma (ICP) analysis. The non-colostomized breeders fed large particle limestone compared to small limestone particles produced a significant increase in percent tibia ash (P < 0.0001) and egg specific gravity (P = 0.0382), but P excretion approached a tendency of being reduced (P = 0.1585). The urinary total P and Ca (∼18 and 9%, respectively) of total P and Ca excretion for breeders fed both sizes of limestone was not significantly different in the colostomized breeders. In plasma, both iP and Ca++ reached a peak during 18 to 20 h and 20 to 24 h post oviposition for smaller and larger particle sized limestone fed groups, respectively. The maximal excretion of urinary P was found during 11 to 20 h post oviposition, whereas urinary Ca peaked during 0 to 11 h post oviposition for both smaller and larger particle sized limestone supplemented groups. In summary, the findings indicate that the particle size (smaller and larger) of calcium source did not significantly influence the quantitative total urinary excretion of Ca and P but did influence the timing of Ca and P excretion.

Effects of chlorine and hydrogen peroxide sanitation in low bacterial content water on biofilm formation model of poultry brooding house waterlines

An in vitro experiment was performed to determine if biofilm would develop when polyvinylchloride (PVC) test coupons (material used for poultry waterlines) were exposed to low bacterial content warm water (≤1000 cfu/mL, test water) and also to determine if biofilm development would be influenced by adding a sanitizer. PVC sections 2.54 cm long and internal diameter of 1. 90 cm were used as test coupons to grow biofilm. Two coupons were immersed in 600 mL test water in a beaker. Nine beakers were utilized similarly with a total of 18 coupons. Three beakers (T1) were treated with a chlorine (Cl) based product (targeted to produce 2 to 4 ppm residual) and the other 3 (T2) with hydrogen peroxide a (HP) based product (targeted to produce 25 to 50 ppm residual). Three untreated beakers served as controls (T3). All beakers and coupons were placed into a water bath shaker under warm and moving water conditions mimicking poultry brooding conditions. Coupons and test water were sampled for treatments for aerobic plate count (APC). Trial 1 used test water with zero cfu bacteria/mL initial APC, whereas the Trial 2 test water initial APC was 3 log10 cfu/mL. Test water samples and coupons had no bacterial growth for all treatments on sampling occasions for Trial 1. In Trial 2, T3 (control) and T2 (HP treated) had APC growth in both test water (2.5 to 3.0 log10 cfu/mL) and on coupons (2 to 2.5 log10 cfu/cm2) on sampling d with no difference (P > 0.05) between these treatments. Whereas, T1 (Cl treated) eliminated bacteria (zero cfu/mL) in test water and inhibited biofilm growth on test coupons (≤0.2 log10 cfu/cm2) during sampling d (P < 0.05). This experiment showed that biofilm can develop in minimally contaminated water even in the presence of sanitizers, yet chlorine was more effective than hydrogen peroxide in limiting this development.

Effect of chlorine treatment on inhibition of E. coli serogroup O2 incorporation into 7-day-old biofilm on polyvinylchloride surface

Poultry waterlines are constructed using polyvinylchloride (PVC) material on which bacterial biofilm can easily form. Biofilm can harbor pathogens including avian pathogenic E. coli (APEC) strains. An in vitro evaluation was performed to determine if E. coli sero group O2 (avian pathogenic) could attach on a PVC surface that had pre-formed biofilm and if this phenomenon could be affected when water was treated with chlorine. Initially, biofilm growth was induced in PVC test coupons (15.16 cm2) for a 7-day period mimicking the waterline scenario in the first wk of poultry brooding; and then this biofilm was challenged with E. coli O2 seeded water in presence/absence of chlorine treatment. After rinsing, test coupons were sampled for bacterial (APC) and E. coli O2 enumeration at various occasions post seeding the pathogen and chlorine treatment. Day 7 APC recovered from coupons was 4.35 log10 cfu/cm2 in trial 1 and 3.66 log10 cfu/cm2 in trial 2. E. coli O2 was not recovered from chlorine treated test coupons (P < 0.05), whereas it was retrieved from untreated coupons (untreated contained > 3 log10 cfu/cm2 in trial 1 and > 2 log10 cfu/cm2 in trial 2). This study suggests that E. coli O2 can incorporate into pre-formed biofilm on a PVC surface within 24 h if water sanitation is not present, and the attachment time of the pathogen can prolong in the absence of already formed biofilm.

Undiagnosed Ectopic Pregnancy among Unsupervised use of Medical Abortion pills

Aims: To identify and share the experience of clinical presentation and management of ectopic pregnancy (EP) in women who presented with unsupervised use of Medical abortion (MA) pills.Methods: A prospective study was conducted in department of Obstetrics and Gynaecology of Civil Service Hospital over one year (March 2015- February 2016). Women with a history of unsupervised use of MA pills were taken into study group as there has been a trend of taking theses pills without consultation in recent days. Detail clinical, menstrual, obstetrics and MA history were taken. Relevant investigations and Ultrasonography were done. Women diagnosed to have ectopic pregnancy were followed and their operative findings were recorded. Results: Ninety-six women presented with unsupervised use of MA, among which 8 (8.33%) diagnosed to have EP. Most women were 20-30 years of age and 37.5% were unmarried.  They gave history of taking MA from pharmacy. Among eight women, 37.5 % had taken MA at the period of gestation <5 weeks, 37.5% between 5-7 weeks and 25% >7-9 weeks. Fifty percent attended hospital after seventy- two hours of MA. Majority (50%) presented with lower abdominal pain and ruptured EP with hemoperitoneum (>one litre) requiring blood transfusion. History of easy availability and social reasons for MA intake were given by 37.5% each.Conclusions: Even though medical abortion is easily accessible, affordable and available, it should also be safer. It is of utmost importance to take it from health facility or a registered medical practitioner following World Health Organization (WHO) guidelines, one of which is excluding extra-uterine pregnancy.

Evaluation of chlorine dioxide based product as a hatchery sanitizer

Formaldehyde is commonly used to overcome contaminants introduced by hatching eggs or water supply in the hatcher cabinets. However, health risks associated with its use make economical alternatives important. This project evaluated a chlorine dioxide based product (CDBP) (0.3% concentrate) as a hatchery sanitizer in decontaminating microbial populations on the shell surface of hatching eggs (>18 d old), as well as its impact on hatchability and chick performance. Hatchers (0.20 m2) designed to hold approximately 50 eggs and equipped with circulation fans, heaters, and thermostats were used for the evaluation. For each of the 2 trials conducted, 450 hatching eggs were obtained and incubated in a common setter. Eggs used in trial 1 were floor eggs whereas in trial 2 nest eggs were used. On d 18 of incubation, eggs were removed from the setter, and viable eggs were randomly allocated to 9 hatchers. Pre-treatment egg rinse samples (10 eggs per hatcher) were collected for initial microbial analysis. Three hatchers were treated with CDBP and 3 hatchers with a formaldehyde based product (FBP). Three untreated hatchers served as control (C). Prior to hatch, 10 eggs/incubator, not previously rinsed, were used for post treatment microbial counts. The hatched chicks were reared until d 21 in floor pens with a common starter diet. For the CDBP treated eggs, hatchability and chick performance (weight gains, mortality, and FCR on d 7 and d 21) were similar to the other treatments. The application rate of CDBP evaluated in this study was not an effective antimicrobial alternative to formaldehyde for sanitizing hatching eggs in hatcher cabinets prior to hatch.

Loop Electrosurgical Excision Procedure in Cervical Intraepithelial Neoplasia

Aims: To evaluate the treatment outcome and acceptance of LEEP in precancerous cervical lesions.Methods: This is a descriptive study performed in Gynecology Department of Civil Service Hospital, from August 2014 - December 2015 in 28 cases that underwent LEEP forCIN. LEEP was performed as day care procedure under intravenous anesthesia and patient was sent home six hours after procedure. Follow up and further treatment was done after final histopathological reports.Results: Highest percentage ofCIN, 32.14% (9) was seen among 30-39 years age with 16 (57.14%) of parity three and more. 17 (60.71%) presented clinic with symptoms (lower abdominal, backpain, pervaginal discharge) while 11 (39.28%) were diagnosed from routine Pap test. Histopathology revealed four (14.28%)CIN1, eight (28.57%)CIN2, 11(39.28%)CIN3, two adenocarcinoma in situ, one of invasive squamous cell carcinoma, chronic cervicitis and atrophic change with no dysplasia. Margins were negative (satisfactory) in 20 (71.42%) and positive in eight (28.57%) with endocervical involvement in two that required second LEEP while one underwent radical hysterectomy for final diagnosis of invasive squamous cell carcinoma.Conclusions: Hysterectomy is a radical procedure for preinvasive cervical lesions that can be treated with simple procedure like LEEP that saves time and financial resources.

Markers of Autolysis in Acute ST Elevation Myocardial Infarction

INTRODUCTION

The availability of reliable noninvasive markers for infarct-related artery (IRA) patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention (PCI) are not necessary.

METHODS

We conducted a single centered retrospective study of STEMI patients undergoing primary PCI to determine how various factors such as demographic characteristics, risk markers of coronary heart disease, clinical and blood parameters present differently in patients with higher coronary flow and patent infarct related artery from patients with total occlusion at the time of initial angiography and how they affect in outcome of the disease.

RESULTS

MPV level (11.96 fL vs. 10.92 fL, P < 0.001), Lp (a) level (179.57 nmol/l vs 141.16 nmol/l , p < 0.001), CK-MB (290.2 vs. 190.98, P < 0.001), total cholesterol level (4.11 mmol/L vs. 3.8 mmol/L, p < 0.02) in total occlusion group were higher than in the patent IRA group. Wall motion abnormality was 77.2% for 203 patients with total occlusion group and 54.2% for 83 patients with patent IRA group (P<0.01). Mean hospital stay days were higher in total occlusion group as compared to the patent IRA group P < 0.01.

CONCLUSIONS

MVP, Lp (a), TC, and CK-MB levels and myocardial wall motion at the presentation may play the role of markers for IRA patency status that will help in early identification of patients with IRA, for whom repeat thrombolysis or rescue PCI may not be required.

Superparamagnetic iron oxide nanoparticles with variable size and an iron oxidation state as prospective imaging agents

Magnetite nanoparticles in the size range of 3.2-7.5 nm were synthesized in high yields under variable reaction conditions using high-temperature hydrolysis of the precursor iron(II) and iron(III) alkoxides in diethylene glycol solution. The average sizes of the particles were adjusted by changing the reaction temperature and time and by using a sequential growth technique. To obtain γ-iron(III) oxide particles in the same range of sizes, magnetite particles were oxidized with dry oxygen in diethylene glycol at room temperature. The products were characterized by DLS, TEM, X-ray powder diffractometry, TGA, chemical analysis, and magnetic measurements. NMR r(1) and r(2) relaxivity measurements in water and diethylene glycol (for OH and CH(2) protons) have shown a decrease in the r(2)/r(1) ratio with the particle size reduction, which correlates with the results of magnetic measurements on magnetite nanoparticles. Saturation magnetization of the oxidized particles was found to be 20% lower than that for Fe(3)O(4) with the same particle size, but their r(1) relaxivities are similar. Because the oxidation of magnetite is spontaneous under ambient conditions, it was important to learn that the oxidation product has no disadvantages as compared to its precursor and therefore may be a better prospective imaging agent because of its chemical stability.