Nanopore sequencing for identification and characterization of antimicrobial-resistant Escherichia coli and Salmonella spp. from tilapia and shrimp sold at wet markets in Dhaka, Bangladesh

Wet markets in low-and middle-income countries are often reported to have inadequate sanitation resulting in fecal contamination of sold produce. Consumption of contaminated wet market-sourced foods has been linked to individual illness and disease outbreaks. This pilot study, conducted in two major wet markets in Dhaka city, Bangladesh during a 4-month period in 2021 aimed to assess the occurrence and characteristics of Escherichia coli and non-typhoidal Salmonella spp. (NTS) from tilapia (Oreochromis niloticus) and shrimp (Penaeus monodon). Fifty-four individuals of each species were collected. The identity of the bacterial isolates was confirmed by PCR and their susceptibility toward 15 antimicrobials was tested by disk diffusion. The whole genome of 15 E. coli and nine Salmonella spp. were sequenced using Oxford Nanopore Technology. E. coli was present in 60-74% of tilapia muscle tissue and 41-44% of shrimp muscle tissue. Salmonella spp. was found in skin (29%) and gills (26%) of tilapia, and occasionally in muscle and intestinal samples of shrimp. The E. coli had several Multilocus sequence typing and serotypes and limited antimicrobial resistance (AMR) determinants, such as point mutations on glpT and pmrB. One E. coli (BD17) from tilapia carried resistance genes for beta-lactams, quinolones, and tetracycline. All the E. coli belonged to commensal phylogroups B1 and A and showed no Shiga-toxin and other virulence genes, confirming their commensal non-pathogenic status. Among the Salmonella isolates, five belonged to Kentucky serovar and had similar AMR genes and phenotypic resistance patterns. Three strains of this serovar were ST198, often associated with human disease, carried the same resistance genes, and were genetically related to strains from the region. The two undetermined sequence types of S. Kentucky were distantly related and positioned in a separate phylogenetic clade. Two Brunei serovar isolates, one Augustenborg isolate, and one Hartford isolate showed different resistance profiles. This study revealed high fecal contamination levels in tilapia and shrimp sold at two main wet markets in Dhaka. Together with the occurrence of Salmonella spp., including S. Kentucky ST198, a well-known human pathogen, these results stress the need to improve hygienic practices and sanitation standards at markets to improve food safety and protect consumer health.

Association of Serum Magnesium Level with Severity of Neurological Disability in Patients with Acute Ischemic Stroke

Magnesium (Mg) has important effects on vascular system and deficiency of this cation is thought to be a risk factor for cerebrovascular atherosclerosis and complications. The study was planned to find out the association of serum magnesium level with severity of neurological disability in patient with acute ischemic stroke. This cross-sectional descriptive study was conducted in the department of Neurology and Medicine at Mymensingh Medical College & Hospital, Mymensingh from June, 2018 to October, 2019. Patients with acute ischemic stroke were evaluated following informed written consent. Diagnosis was confirmed by neuroimaging of brain. Moreover, serum magnesium assay was done for each patient. Data were collected by interview, clinical examination and laboratory investigations of patients using a case record form and analysis was carried out by using the SPSS 22.0 (IBM Inc., Armonk, NY, USA). Mean age of acute ischemic stroke patients was 63.94±13.93 years with male predominance (58.30%). Majority of the respondents (70.2%) had NIH Stroke Scale (NIHSS) score 5-15 (moderate stroke), 13.1% had score 1-5 (minor stroke), 13.1% had score15-20 (Moderate to severe stroke) and 3.6% had score 21-42 (severe stroke). Mean serum magnesium level was 1.83±0.283mg/dl. Hypomagnesaemia was present in 28(33.3%) patients and it was related with higher NIHSS scoring (p<0.05). Multiple regression showed that among the risk factors, serum magnesium level was independently associated with severity of neurological disability of the acute ischemic stroke (p<0.001). In this study, the correlation coefficient between serum magnesium level and NIHSS score was found as r= - 0.667 which showed negative relationship between serum magnesium and NIHSS score. Lower serum magnesium level is associated with the severity of neurological disability of acute ischemic stroke patient. Further case-control studies are required to validate this finding.

Development and Validation of MRI Imaging Biomarkers for Prostate Cancer Using Deep Learning

PURPOSE/OBJECTIVE(S)

Given the increasing number of treatment options for patients with localized prostate cancer (PCa), there is a need for biomarkers to aid in risk stratification. Specifically, novel biomarkers can aid in the identification of high-risk phenotypes among similar patients in traditional NCCN risk groupings. One promising area for development is using pre-treatment prostate MRI to identify imaging biomarkers to identify prostate cancer patients at highest risk for recurrence. We hypothesized that deep learning could be leveraged to identify imaging biomarkers of aggressive PCa from pre-treatment prostate MRIs.

MATERIALS/METHODS

Our study included 1,020 patients treated at our institution between 2010-2022. Given pathologic extraprostatic extension (EPE) and seminal vesicle invasion (SVI) are associated with higher risk of treatment failure, we hypothesized that deep learning models which identified radiographic EPE and SVI would provide non-invasive imaging biomarkers associated with PCa prognosis. We trained two separate deep learning models using convolutional neural networks to predict SVI and EPE respectively. The model inputs were T2W prostate MRIs (n = 894) and models consisted of 8 convolutional layers. Dropout, L2 regularization, and data augmentation were used to improve model generalizability and reduce overfitting. Discriminatory ability of each model was measured using AUC on a blinded external test set of 221 patients. To assess the clinical utility of our imaging biomarkers, log-rank tests were used to evaluate biochemical free survival (BFS) for patients classified as high risk to patients classified as low risk. Biochemical failure was defined as post-treatment PSA >0.1 for patients who underwent radical prostatectomy (RP) or PSA >2ng/ml above nadir for patients receiving radiation therapy.

RESULTS

Within our cohort of 1,020 patients the median age was 66 with a median follow up of 4 years. 49.3% (n = 503) underwent RP and 50.7% (n = 517) received EBRT. 4% (n = 41) were low risk, 62.4% (n = 636) were intermediate risk, and 33% (n = 337) were high risk based on NCCN criteria. Deep learning models showed good discriminatory ability for both EPE (AUC 0.66) and SVI (AUC 0.74). Both imaging biomarkers showed prognostic ability to identify high risk prostate phenotypes. Patients deemed high risk based on EPE classifier had worse BFS (median 5 vs 9 years, p<.001). Similarly, patients classified as high risk based on SVI also showed worse BFS (median 5 vs 9 years, p = 0.024). Among intermediate risk patients, EPE biomarker showed an ability to identify high risk phenotypes (median 6 vs 9 years, p = 0.024).

CONCLUSION

Deep learning classifiers of prostate MRIs demonstrated the ability to stratify high-risk prostate cancer phenotypes beyond traditional risk paradigms. Imaging biomarkers represent a non-invasive method to help aid in the personalization of treatment for patients with localized prostate cancer and identify patients who potentially require treatment escalation.

Scaling up quality-assured psychotherapy: The role of therapist competence on perinatal depression and anxiety outcomes

OBJECTIVES

To examine: (1) the psychometric properties of two therapist competence measures-multiple choice questionnaire (MCQ) and standardized role-plays; (2) whether therapist competence differed between non-specialist (NSPs) and specialist (SPs) providers; and (3) the relations between therapist competence and patient outcomes among perinatal patients receiving brief psychotherapy.

METHODS

This study is embedded within the SUMMIT Trial-a large, ongoing psychotherapy trial for perinatal women with depressive and anxiety symptoms. We assessed the: (1) psychometric properties of therapist competence measures using Cronbach's alpha and inter-class correlation; (2) differences in therapist competence scores between n = 23 NSPs and n = 22 SPs using a two-sample t-test; and (3) relations between therapist competence measures and perinatal patient outcomes through a linear regression model.

RESULTS

Internal consistency for role-play was acceptable (α = 0.71), whereas MCQ was excellent (α = 0.97). Role-play showed good inter-rater reliability (ICC = 0.80) and scores were higher for SPs compared with NSPs (t(2,38) = -2.86, p = 0.0069) and associated with outcomes of anxiety (B = 1.52, SE = 0.60, p = 0.01) and depressive (B = 0.96, SE = 0.55, p = 0.08) symptom scores.

CONCLUSIONS

Our study highlights the importance of demonstrating psychological treatment skills through standardized role-plays over knowledge-based competence to predict perinatal patient outcomes. Using well-defined evidence-based tools is critical for deploying NSPs to provide high-quality psychotherapy and increase accessibility to psychological treatments for perinatal populations worldwide.

Culturally sensitive psychotherapy for perinatal women: A mixed methods study

OBJECTIVE

There is a critical need to better understand psychological treatments from a culturally sensitive lens. Using a process-oriented model, we examined treatment satisfaction among perinatal patients who received behavioral activation (BA) within a large psychotherapy trial for perinatal depression and anxiety, and explored how to optimize culturally sensitive delivery through a multistakeholder perspective.

METHOD

In this mixed methods study, we estimated treatment satisfaction through mean client satisfaction scores (Client Satisfaction Questionnaire [CSQ]-8) among perinatal participants (N = 417) using one-way analysis of variance. We also conducted semistructured interviews with 20 ethnically diverse perinatal participants, 19 treatment providers, and five clinical leads. We employed content analysis to identify barriers, facilitators, and strategies for delivering culturally sensitive treatment.

RESULTS

CSQ-8 scores were similar across ethnic groups, F(7, 409) = 0.70, p = .67. Most participant interviewees reported that topics of race, ethnicity, and culture were raised during treatment sessions and that providers were able to address these topics in a culturally sensitive way. Despite this, almost all providers and clinical leads reported insufficient training to deliver culturally sensitive psychotherapy. The most-endorsed challenge for participants and providers was apprehension to bring up issues of race and ethnicity during treatment. Key facilitators included provider style, previous training, ongoing training resources, and supervision.

CONCLUSION

BA offers one psychotherapeutic model that uses an idiosyncratic and process-oriented approach that fosters intersectional humility and benefits from cultural humility, comfort, and opportunities. We identify key recommendations to inform culturally sensitive, evidence-based psychological treatments that include explicitly acknowledging and eliciting topics of race, ethnicity, and culture during sessions and supervision and ongoing training and supervision. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Complications and Management of Neck Space Infection

Background: Neck Space Infections are serious and common diseases that involve several spaces in the neck. Deep neck space infections can be life threatening in diabetic, immunocompromised and elderly patients and special attention should therefore be given to these groups. Objectives: This study was conducted to assess complications of deep neck space infections and its management, etiology, risk factors, presentation, spaces affected and complications among patients admitted in Department of ENT and Head- Neck Surgery in Dhaka Medical College & Hospital. Methods: This was a Cross Sectional Study conducted in the ENT and Head- Neck Surgery Department, Dhaka Medical College & Hospital from January 2016 to June 2016. A total of 150 patients were included who fulfill the selection criteria. Purposive sampling was used to collect data. Statistical analysis was done by SPSS version 21. Results: More than half of the patients (53.30%) came from middle class. Diabetes Mellitus was the most common risk factor (74.5%). Almost all patients presented with neck pain followed by neck swelling, dysphagia, fever and trismus. Organism isolated from drainage fluid was polymicrobial. Streptococcus (51.34%) and staphylococcus (18.60%) were most common organisms isolated. Airway was secured first and then high doses of antibiotics, immediate surgical drainage under local anesthesia were done in 130 (86%) patients. Commonly used antibiotics were ceftriaxone 132(82%), Metronidazole 113(75%) and flucloxacillin 98(65%). Complications were recorded in 55 patients. Most common was airway complication 40(73%). Tracheostomy was done in 17(11.33%) patients. Mortality occurred in 17(11.33%) patients. Conclusion: Early diagnosis and management is essential to prevent complications. Odontogenic infections, poor oral hygiene, lack of nutrition, smoking and tobacco chewing, DM were associated with neck space infection and we can prevent & control those factors. Bangladesh J Otorhinolaryngol 2022; 28(1): 56-61

Adapting behavioral activation for perinatal depression and anxiety in response to the COVID-19 pandemic and racial injustice

BACKGROUND

We examined the implementation of a brief, behavioural activation (BA) model, via telemedicine, for perinatal populations during a confluence of significant global events in 2020. We conducted a rigorous qualitative study to identify relevant barriers and facilitators from the perspectives of both perinatal participants and treatment providers. We also present two case studies where BA was used and adapted to provide patient-centered care.

METHODS

Within the ongoing SUMMIT non-inferiority randomized controlled trial in Canada and USA, we interviewed a random selection of perinatal participants (n = 23) and all treatment providers (n = 28). A content analysis framework was developed to identify relevant barriers and facilitators and frequencies were calculated for each emergent theme within and across respondent groups.

RESULTS

Key facilitators reported by participants receiving BA were that BA helped with support and social connection (73.9%), creative problem solving (26.1%) and attending to pandemic-related symptoms (21.7%). Key facilitators endorsed by providers delivering BA were the use of telemedicine (35.7%) and loosening of government restrictions (21.4%). Both participant groups reported similar barriers to BA during the pandemic such as a lack of privacy and limited activities due to pandemic restrictions. However, providers were more likely to endorse pandemic-related life stressors as a barrier to treatment delivery compared to participants (64.3% vs. 34.8%). Both participant groups experienced explicit discussion of race and the racial justice movements during sessions as beneficial and reported harms of not doing so to the therapeutic alliance.

CONCLUSIONS

BA offers a person-centered model to facilitate social connection through creative problem-solving for women with perinatal depressive and anxiety symptoms within the context of the COVID-19 pandemic. Explicit discussion of race and racial injustice during sessions is an important and helpful aspect in psychological treatments.

Quality of Life of Bangladeshi Doctors in the COVID-19 era: Are We Taking Good Care of Our Carers?

The Coronavirus pandemic has been affecting our healthcare professionals physically as well as psychologically since March 2020. Whilst various measures have been taken to protect their physical health, their mental wellbeing has not been brought into attention. We aimed to assess the well-being of Bangladeshi doctors and identify the high-risk group using a core-10 validated form. We performed an observational cross-sectional survey among Bangladeshi healthcare professionals. One hundred one (101) doctors filled out the core-10 form. We collected data over a 1-month-period during the first peak of COVID-19. According to our data, majority of the participants (49%) felt anxious or nervous at some point. Thirty one percent (31%) felt hopeless, unhappy even panic attacks but most significant finding was that 21% participants had at least once thought about ending their lives. This is a matter of concern and the workplaces should identify the vulnerable professionals so that they can be supported better mentally and socially. More than half of the participants (55%) were found to have moderate to severe depression in the first peak of COVID 19 pandemic. This is not over yet; more waves are coming. Therefore, it is really important that we address this issue before it is too late and ensure regular counselling, better childcare for working parents, safety measures to protect their families and financial security. Otherwise, we might exhaust our carers to a level where even they cannot help us survive this global challenge.

FeedMaster: A least-cost feed formulation App for minimizing the cost and maximizing milk yield

Objective: The study aimed to develop and assess an Android app designed for farmers with a low educational status that can formulate a least-cost ration. Materials and Methods: First, a computer-android-based app named BLRI FeedMaster was developed to guide users in formulating a balanced ration at the least cost. A survey was conducted on 30 livestock officers and 18 farmers with 50 cattle to evaluate its efficacy at the field level. The study outcomes were milk yield, feeding cost, milk composition, time, and cost for management before and after using the BLRI FeedMaster app. Descriptive statistics and paired sample t-tests were used to analyze the data. Results: After adopting the BLRI FeedMaster app, a significant increase was observed in daily average milk yield (9.39 ± 0.32 l from 8.37 ± 0.36 l), while a considerable decrease was observed in daily average feed quantity (4.88 ± 0.15 kg from 5.60 ± 0.17 kg) and feed cost (BDT 28.00 ± 0.50 from BDT 29.75 ± 0.49). Besides, the number of visits, time, and cost for seeking professional services regarding feed, health care, and other information was significantly minimized. The number of visits decreased to 0.36 ± 013 from 3.07 ± 0.38, and the consumed time was reduced from 270 ± 34.30 to 235.71 ± 59.42 min (p < 0.05) after adopting the app. Conclusion: Hence, this app was very beneficial for farmers with a low economic and educational background and may ultimately help farmers with profitable animal farming and sustainable pro¬duction in the least developed countries like Bangladesh.

Prevalence of Hepatitis B Virus Infection among Children with Liver Disease Admitted In Mymensingh Medical College Hospital

Hepatitis B virus infection is an important cause of liver disease. Hepatitis B Virus may present with varying degree of severity. In older children, 5-10% cases leading to chronic liver disease, cirrhosis and hepatocellular carcinoma. This descriptive cross sectional study was done to assess the prevalence of Hepatitis B Virus infection among hospitalized children with liver disease in pediatric department of Mymensingh Medical College Hospital, Bangladesh from December 2015 to October 2016. All the children of both sexes having age between six months to twelve years admitted in the pediatric ward with acute or chronic liver disease were included in this study by purposive sampling. A written consent was obtained from legal guardian of children before inclusion. Ethical clearance was obtained from competent authority. A detailed history was taken from parents in each case according to pre-designed questionnaire about demography of the patients and the risk factors of the liver disease. A thorough clinical examination and available relevant investigations like serological testing for HBV infection was done in all patients. We had figure out the seropositivity of HBV among patients having liver disease by doing HBsAg and Anti-HBc IgM. Progress of the patient was monitored by daily clinical examinations and by investigating HBsAg and Anti-HBc IgM. Finally data analysis was done by SPSS version 21.0. Among total 100 patients most (44%) patients were in 7-10 years old and most (62%) of the participants were male. Acute liver disease was 58% cases and chronic liver disease was 42% cases. HBsAg was positive in 1 case among acute liver disease and 5 cases among chronic cases. Total 6 (six) patients were found positive for HBsAg. Anti HBc IgM was positive in 4 patients among acute liver disease. Among these Anti HBc IgM positive (4) patients only one had both HBsAg and Anti HBc IgM positive. So, four patients were confirming suffered from acute viral hepatitis because they had anti HBc IgM positive. On the contrary 5 patients suffered from chronic hepatitis by hepatitis B because they were only HBsAg positive. So, in this study 9 patients (9%) were confirming suffered from HBV infection. Possible transmission factors of hepatitis B were history of (H/O) blood transfusion/trauma/parenteral injection, H/O umbilical sepsis, H/O maternal illness/infection during pregnancy. HBV still is a major cause of morbidity. All the children with liver disease should be routinely tested for HBV.

Status and conservation needs of Cycas pectinata Buch.-Ham. in its natural habitat at Baroiyadhala National Park, Bangladesh

The widespread cycad Cycas pectinata was first discovered in the Bengal region by William Griffith in Baroiyadhala forest of Chattogram in 1838. In Bangladesh, this species is confined to a few hills at Baroiyadhala, Sitakunda upazila of Chattogram district. Though the Baroiyadhala forests were declared a national park in 2010, the loss of this native gymnosperm from this forest is alarming. The present study aimed to assess the status of C. pectinata populations in its native range, identify the drivers responsible for ongoing losses, and identify locations of C. pectinata occurrence in Baroiyadhala National Park suitable for in situ conservation. A random quadrat survey with 21 sample plots of 100 × 100 m was conducted during April–June 2018 in Baroiyadhala National Park. Population and growth data for C. pectinata were collected from each sample plot, along with observations of disturbances. Four focus group discussions (FGDs) were conducted with adjacent local people. The study revealed presence of 12 C. pectinata individuals per hectare and five seedlings per hectare in the study area, and significant numbers of dead and burned Cycas were also found in some sites. Based on density, five C. pectinata hotspots were identified for in situ conservation programs. Habitat destruction, indiscriminate fire, and unsustainable harvesting of leaves and male and female cones are responsible for rapid declines in C. pectinata populations in its wild habitat. Measures for protection and restoration of the species are creating awareness among the local people about ecological importance of this species; enhancing protection; banning trade of Cycas; creating opportunities of sustainable livelihood for local people to reduce dependency on forests.

Detection of Antimicrobial and Heavy-Metal Resistance Genes in Aeromonas spp. Isolated from Hard-Shelled Mussel (Mytilus Coruscus)

Hard-shelled mussel (Mytilus coruscus) is a popular seafood in South Korea because of its delicacy and high nutritional value. Our study aimed to identify antimicrobial and heavy-metal resistance determinants in Aeromonas isolates from marketed hard-shelled mussel in South Korea. A total of 33 Aeromonas species were isolated, and antimicrobial disk diffusion test was done to observe antimicrobial resistance patterns. In addition, broth microdilution test was performed to determine resistance to heavy-metals. PCR amplification was done to detect resistance genes. High resistance to amoxicillin (100.0%), ampicillin (93.9%), rifampicin (78.8%), and cephalothin (48.5%) was observed where least resistance to other antimicrobials was also detected. In addition, the isolates showed high resistance to cadmium (Cd) (57.6%), and 42.4% and 27.3% were resistant to chromium (Cr) and copper (Cu). The occurrence of antimicrobial resistance genes, such as blaTEM, blaSHV, blaCTX-M, tetB, tetE, and intI1 genes, was observed in 9 (27.3%), 8 (24.2%), 8 (24.2%), 6 (18.2%), 5 (15.2%), and 9 (27.3%) isolates, respectively. Also, heavy-metal resistance genes, czcA, copA, and merA were detected in 17 (51.5%), 11 (33.3%), and 7 (21.2%) of the isolates, respectively. The results suggest that mussels are a reservoir of multidrug and heavy-metal-resistant Aeromonas spp.

The interactive process of negotiating workplace accommodations for employees with mental health conditions

BACKGROUND

Implementing workplace accommodations is an effective means of retaining employees with mental health conditions. However, the process is poorly understood and poorly documented.

OBJECTIVE

The purpose of this research is to explore the interactive process of negotiating workplace accommodations from the perspective of employees with mental health conditions and workplace stakeholders.

METHODS

We interviewed employees across Canada who self-identified as having a mental health condition requiring accommodations, and six stakeholders at various workplaces across Canada who are involved in providing accommodations. Data were analyzed using a qualitative descriptive approach to identify key themes.

RESULTS

The findings highlight that the process of negotiating accommodations is non-linear, interactive, and political. The process is shaped by organizational and political factors and collaboration between stakeholders.

CONCLUSIONS

The negotiation process is a combination of social, relational and political factors. Clear and accessible accommodation policies, workplace awareness and specific workplace training on how to implement accommodations are needed to optimize the accommodation process for all involved.

272 Morbid Obesity in Lower Limb Arthroplasty: Short Length of Stay and Favourable One-Year Outcomes

Introduction

There are concerns that BMI is associated with a greater length of stay (LOS) and perioperative complications in lower limb arthroplasty.

Method

We analysed data from a six-month period to see if there was a correlation between BMI and LOS. We performed a subgroup analysis for patients with morbid obesity (BMI &gt;40).

Results

285 TKRs and 195 THRs were analysed. For TKRs, the average length of stay was 2.7 days. There was no significant correlation between BMI and LOS (r=-0.0447, p = 0.2267). The morbidly obese category (n = 33) had the shortest LOS (2.5 days) compared to other BMI categories. 30-day readmission rate was 6%. 90-day re-admission rate was 12%. Six patients had minor wound issues requiring no intervention or antibiotics only. The was one prosthetic joint infection, one stitch abscess, one DVT and one patellar tendon injury.

For THRs, the average LOS was 2.9 days. There was no significant correlation between BMI and LOS (r = 0.007, p = 0.4613). The morbid obese category (n = 9) had the shortest LOS (1.9 days) compared to other BMI categories. No patients were readmitted within 90 days or had documented complications.

Conclusions

Increased BMI is not associated with increased LOS. The morbidly obese had the shortest LOS, and commendable complication and re-admission rates.

Relation between Serum Magnesium Level and Migraine

Migraine is one of the most disabling types of headache. It affects 4-6% of men and 13-18% of women; more than 80% of them are under 30 years. Many theories to explain mechanism of migraine are present; role of serum magnesium is one of them. This Cross-sectional analytical study was designed to see serum magnesium level status of migraine patients in Bangladesh and to find out any relation. The study was carried out in Outpatient Department of Neurology of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2017 to September 2018. Seventy (70) patients between 18-60 years of both sexes with headache fulfilling the criteria for migraine were enrolled as migraine group. Patients with headache who did not fulfill the criteria of migraine enrolled as non migraine group. Patients were included in both groups after exclusion of structural lesions, magnesium containing drug intake, pregnancy, menstruation, alcoholism, renal or GIT problems. Serum magnesium levels were studied in both groups and compared with each other. All related factors such as age, sex, family history of migraine, occupation were assessed. Fifty one (51) of 70 patients (72.85%) was female and 19(27.15%) were male in migraine group. Thirty eight (54.28%) of cases were between 18 and 30 years old. Thirty nine (55.71%) of migraine patients had history of similar headache in their family. Severe headache in 51.43% of migraine patients and 30% had more than three attacks per month. Mean serum magnesium level was 1.70 mg/dl in migraine group and 1.85 mg/dl in non migraine group (p=0.001). Serum magnesium level was also lower in severe migraine headache in comparison to mild to moderate headache (p=0.01). No significant difference was found in serum magnesium level compared according to age, sex, frequency of attack and presence or absence of aura. The study concludes that serum magnesium in migraine patients was significantly lower than non migraine group. It was also lower in migraine patient having severe headache in comparison with mild to moderate headache, though in both conditions they were within normal range.

A multi-centre, cross-sectional study on coronavirus disease 2019 in Bangladesh: clinical epidemiology and short-term outcomes in recovered individuals

Coronavirus disease 2019 (COVID-19) rapidly became a global pandemic. This study aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) -associated epidemiology and clinical outcomes in Bangladesh in order to understand the future course of the COVID-19 pandemic and develop approaches to prevention. A cross-sectional study based on retrospective interviews was conducted on 1021 individuals with RT-PCR-confirmed COVID-19 admitted in six different hospitals in Bangladesh and who recovered 4 weeks before the interview date. Of the 1021 patients, 111 (10.9%) were asymptomatic and the other 910 (89.1%) were symptomatic. Higher prevalence of COVID-19 was found in the male population (75%), in cohorts with B-positive blood group (36.3%) and in the 31-40 years age group. Common symptoms observed in our study participants were fever (72.4%), cough (55.9%), loss of taste (40.7%) and body ache (40%); whereas among the biochemical parameters, neutrophil count (46.4%), D-dimer (46.1%) and ferritin (37.9%) levels were elevated. Among the recovered individuals, short-term outcomes including pains and aches (31.8%), weakened attention span (24.4%) and anxiety or depression (23.1%) were also significantly prevalent in the symptomatic cases with comorbidities. Our study showed that in Bangladesh, adult males aged between 31 and 40 years were more vulnerable to developing COVID-19. It also indicated a rising trend of asymptomatic cases as the pandemic progressed. As a consequence, deployment of interventions to curb further spread of community infection is necessary to avoid grave outcomes of COVID-19 in Bangladesh.

Ornamental fish: a potential source of pathogenic and multidrug-resistant motile Aeromonas spp

Aeromonas spp. are ubiquitous bacteria that cause diseases in fish and other aquatic animals. They are the natural inhabitants of different aquatic environments, such as freshwater, brackishwater and marinewater. Extrinsic stressors, such as crowding, unhygienic handling, poor water quality, polluted feeding and inadequate nutrition, can predispose fish to Aeromonas infection. In ornamental fish, motile Aeromonas spp. are known as aetiological agents of motile aeromonad infections, which cause significant mortality in fish and economic loss in the ornamental fish industry. The existence of different virulence factors leads to the virulence potential of motile Aeromonas spp. There are several antimicrobials used to treat bacterial infections in ornamental fish. However, the extensive use of antimicrobials in the ornamental fish industry causes multidrug resistance. This article reviewed a multitude of virulence factors that are related to the ornamental fish-borne Aeromonas pathogenicity and the antimicrobial resistance determinants related to the multidrug resistance phenotypes of motile Aeromonas spp. in ornamental fish.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

FRI0438 POST-CHIKUNGUNYA CHRONIC ARTHRITIS - SHARING OF BANGLADESH EXPERIENCE OVER ONE YEAR FOLLOW UP OF 60 PATIENTS

Background:

Chikungunya virus (CHIKV) infection is an emerging disease which is responsible for several epidemics around the world1. Systematic review and meta-analysis had shown that approximately 25% of cases of Chikungunya(CHIK) would develop CHIK-Chronic Inflammatory Rheumatism and 14% would develop persistent arthritis (or spondylitis)2.

Objectives:

To describe the frequency of the clinical patterns of chronic arthritis & to characterize the clinical symptoms in a Bangladeshi cohort of CHIK patients 12months post-infection.

Methods:

In 2017, a Chikungunya outbreak occurred in Dhaka, Bangladesh, during which a prospective cohort of CHIK patients with confirmed diagnosis was constituted. A longitudinal follow up of 60 patients from an initial cohort of 142 patients, attending the out-patient department of Rheumatology, BSMMU, was done. Patients having arthritis/ arthralgia or both lasting more than 3 months were considered as chronic cases. Their baseline and follow-up symptoms at 3m, 6m and 12months were evaluated. Functional status was assessed with the Bengali Version Health Assessment Questionnaire (HAQ).

Results:

Of the initial 142 patients enrolled in the study, 135(95.1%) had CHIKV-IgM and 29(20.4%) had IgG positive. Patients that followed up in-person were predominantly adult (age 43.73 ± 11.09 years) and female 34 (56.7%). The majority of the patients 35 (58.3%) had undifferentiated arthritis. After three months, 8 (16.3%) had oligoarthralgia, 26 (53.1%) had polyarthralgia and 8 (16.3%) had polyarthralgia with oligoarthritis. At the end of one year, 13 (21.7%) patients underwent complete remission. Among the 47 patients, 21 had joint involvement where 11(52.4%) had polyarthralgia, 5(23.8%) had polyarthralgia with oligoarthritis, 5 (23%) had oligoarthralgia and 4 (19%) had monoarthralgia. Among the 47 patients, mild, moderate and severe functional disability was present in 89.4%, 6.4% and 4.3% patients respectively.

Conclusion:

After one year of follow up, one-third of the patients remained symptomatic. Polyarthralgia was the predominant clinical feature. Mild functional disability was also observed in a significant number of patients.

References:

[1]Ali Ou Alla S, Combe B. Arthritis after infection with Chikungunya virus. Best Pract Res Clin Rheumatol. 2011;25(3):337-46.

[2]Rodríguez-Morales AJet al.Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis.Arthritis. Care. Res. 68(12), 1849-1858 (2016).

Table 1.

Socio-demographic and clinical pattern of patients with Chronic CHK arthritis (n=60)

Variablesn(%)Age (in years)Mean ±SD43.73 ±11.1SexFemale34 (56.7)Male26 (43.3)First joint involvementGeneralized34 (56.7)Ankle12 (20.0)Knee6 (10.0)Wrist5 (8.3)Others (MTP, shoulder, neck and axial plane)3 (5.0)Clinical patternUndifferentiated35(58.3)Spondyloarthritis10 (16.7)Rheumatoid Arthritis7 (11.7)Pre-existing Spondyloarthritis6(10.2)Pre-existing Rheumatoid Arthritis1(1.7)Pre-existing Osteo-arthritis Arthritis1(1.7)Table 2.

Joint involvement of patients with Chronic CHIK arthritis

Joint characteristics3 m (n=49)6 m (n=36)1yr (n=21)f(%)f(%)f(%)Type of involvement in persistent painJoint only33 (55.0)28 (46.7)20 (33.3)Both joint & soft-tissue16 (26.7)8 (13.3)1 (1.7)Joint involvementMonoarthralgia1 (2.0)5 (13.9)4 (19.0)Oligoarthralgia8 (16.3)6 (16.7)5 (23.0)Polyarthralgia26 (53.1)18 (50.0)11 (52.4)Monoarthritis1 (2.0)0(0.0)0(0.0)Oligoarthritis6 (12.2)3 (8.3)0(0.0)Polyarthritis7 (14.3)9 (11.1)1 (4.8)Oligoarthralgia & monoarthritis1 (2.0)0 (0.0)0 (0.0)Polyarthralgia & monoarthritis0 (0.0)1 (2.8)0 (0.0)Polyarthralgia & oligoarthritis8 (16.3)4 (11.1)5 (23.8)Polyarthralgia & Polyarthritis1 (2.0)0 (0.0)0 (0)

Disclosure of Interests:

None declared

0353 Objectively Measured Sleep and Components of Metabolic Syndrome in Well-Functioning Older Adults

Introduction

Prior studies tying sleep to metabolic syndrome in older adults have mostly used self-report sleep measures. We investigated the association between actigraphic sleep parameters and metabolic syndrome components in well-functioning older adults.

Methods

We studied 434 participants in the Baltimore Longitudinal Study of Aging (aged 71.1±12.8 years, 41.4% women) with 6.6±1.0 nights of wrist actigraphy and data on metabolic syndrome components: blood triglyceride (TG) level &gt;150 mg/dL; high density lipoprotein (HDL) &lt;50 mg/dL; and waist circumference (WC) &gt;88.9 cm for women and &gt;101.6 cm for men. Sleep parameters were the primary predictors and metabolic syndrome components the outcomes. Logistic regression was performed, and results are expressed as odds ratio (OR) with p-values.

Results

After adjusting for age, sex, race and education, higher sleep efficiency (SEFF; per 10%) was associated with a lower odds of high WC (SEFF OR=0.60, p=0.01) and, compared to participants in the intermediate total sleep time tertile (5.5 to 6.8 h), those in the shortest tertile (&lt;5.5 h) had a slightly lower odds of high WC (TST OR=0.98, p=0.02). In adjusted models, greater wake after sleep onset (WASO; per 30 min), greater average wake bout length (WBL; per min), and lower SEFF (per 10%) were associated with a greater odds of poor HDL level (&lt;50 mg/dL) (WASO OR=1.37, p=0.05; WBL OR=1.49, p=0.007; SEFF OR=0.72, p=0.04). After further adjustment for BMI and depressive symptoms, only the association between longer WBL and poor HDL level remained significant (OR=1.48, p=0.01). There were no associations between sleep parameters and TG level.

Conclusion

Among well-functioning older adults, greater WASO but lower TST and SE are associated with poorer metabolic syndrome components. Longitudinal research is needed to evaluate the temporal associations of objectively measured poor sleep and metabolic syndrome components and evaluate the roles of BMI and depressive symptoms in these associations.

Support

The first author is supported by a Postdoctoral Fellowship by the Intramural Research Program (IRP) at the National Institute on Aging (NIA). This study was supported in part by National Institute on Aging (NIA) grant R01AG050507, the NIA Intramural Research Program (IRP), and Research and Development Contract HHSN-260-2004-00012C.

Aeromonas spp. Isolated from Pacific Abalone (Haliotis discus hannai) Marketed in Korea: Antimicrobial and Heavy-Metal Resistance Properties

Antimicrobial and heavy-metal resistance of 29 Aeromonas spp. (Aeromonas hydrophila n = 9, Aeromonas enteropelogenes n = 14, Aeromonas veronii n = 3, Aeromonas salmonicida n = 2, and Aeromonas sobria n = 1) isolated from Pacific abalone marketed in Korea were analyzed. All isolates were found to be resistant against ampicillin. High level of resistant to cephalothin (86%), rifampicin (73%), imipenem (42%), and oxytetracycline (35%) were also detected. Thirteen (45%) of the isolates showed multiple antimicrobial resistance (MAR) index ≥ 0.2. The PCR assays implied the presence of qnrS, qnrB, qnrA, tetB, tetA, aac (3')- IIa, aac(6')-Ib, aphAI-IAB, bla_CTX, bla_TEM, and intI1 genes among 76%, 28%, 14%, 17%, 3%, 3%, 41%, 10%, 41%, 28%, and 66% of the isolates, respectively. Class 1 integron gene cassette profiles aadA1(3%) and aadA2 (3%) were also identified. Lead (Pb) resistance was the highest (69%) among 5 heavy metals tested, whereas 38%, 27%, and 20% of the isolates were resistant to Cadmium (Cd), Chromium (Cr), and Copper (Cu), respectively. Heavy-metal resistance genes, CopA, CzcA, and merA were positive in 83%, 75%, and 41% of the isolates, respectively. In conclusion, observed genotypic and phenotypic resistance profiles of Aeromonas spp. against antimicrobials and heavy metals reveal the ability of serving as a source of antimicrobials and heavy-metal-resistant traits.

Emergency Tracheostomy in a Tertiary Level Hospital in Bangladesh: Indications and Complications

Objective: To see the common indications, pattern of complications (during and post operative) of emergency tracheostomy in the tertiary level hospital in Bangladesh. It also gives the idea for minimizing the complications. Methods: This cross sectional study was carried out in the Department of Otolaryngology & Head- Neck surgery of Dhaka Medical College Hospital, Dhaka, from 14th April 2015 to 14th October 2015. This study includes all emergency patients irrespective of age and sex whose tracheostomy was done in emergency operation theatre of ENT department of Dhaka Medical College and Hospital. Results: The study reveals that the commonest indications of emergency tracheostomy were diagnosed case of carcinoma of larynx & base of tongue (30%) followed by post-irradiated carcinoma larynx (24%). Next common indications were stridor in undiagnosed case (18%), difficulty in intubation during surgery (10%), history of road traffic accident (6%), cut throat injury (6%), foreign body in throat (2%), laryngeal edema and blunt trauma in neck (2%) respectively. Commonest complications during the procedure were apnoea (12%), haemorrhage (18%), injury to surrounding structure (10%), cardiac arrest (4%) & respiratory arrest (2%). Common complications in early post operative period were surgical emphysema (10%), crusting or blockage (4%), tube dislodgement (4%), &stomal infection (2%). Late post operative complications were stomal granulation tissue (4%), pneumonia (2%), stomal infection (2%), tracheocutaneous fistula (2%), & tracheomalasia (2%). Bangladesh J Otorhinolaryngol; October 2016; 22(2): 96-101

Species identification, virulence markers and antimicrobial resistance profiles of Aeromonas sp. isolated from marketed hard-shelled mussel (Mytilus coruscus) in Korea

Hard-shelled mussel (Mytilus coruscus) is a popular seafood in Korea. This study aimed to determine the virulence markers and antimicrobial resistance patterns of 33 Aeromonas strains isolated from mussels. The isolates were identified as A. salmonicida (n = 14), A. veronii (n = 9), A. enteropelogenes (n = 4), A. caviae (n = 3), A. allosaccharophila (n = 2) and A. bivalvium (n = 1) by gyrB gene sequencing. The sequence divergence between and within the species ranged from 3·70 to 10·40% and 0-1·50% respectively. Every species formed a distinct group in a neighbour-joining phylogenetic tree. The DNase, gelatinase, caseinase, β-haemolysis, biofilm and lipase activities were observed in 33 (100·00%), 31 (93·93%), 30 (90·90%), 27 (81·81%), 21 (63·63%) and 17 (51·51%) isolates respectively. The virulence genes were detected by PCR in the following frequencies: fla (90·09%), aer (87·88%), hlyA (87·88%), ahyB (81·19%), gcaT (75·76%), ser (69·70%), lip (66·67%), alt (57·58%), ast (51·51%) and act (21·21%). Every isolate was resistant to at least three of 18 antimicrobials in the disk diffusion test. The multiple antimicrobial resistance index values ranged from 0·11 to 0·44 among the isolates. Our study suggests that mussels can be a potential reservoir of virulent and multidrug-resistant Aeromonas sp. SIGNIFICANCE AND IMPACT OF THE STUDY: Aeromonas sp. are known as common pathogenic bacteria isolated from seafood. The virulence factors and antimicrobial resistance profiles of mussel-borne Aeromonas sp. are poorly understood. This study demonstrated for the first time the existence of virulence markers and antimicrobial resistance of Aeromonas sp. from mussels in Korea. Majority of the isolates were positive for phenotypic virulence characteristics and harboured several virulence genes which reveal the potential virulence of mussel-borne Aeromonas sp. Multiple antimicrobial resistance was also observed among the isolates. Our study highlights the importance of food safety standards in mussel consumption.

Prevalence of virulence and antimicrobial resistance genes in Aeromonas species isolated from marketed cockles (Tegillarca granosa) in Korea

This study aimed to examine incidence, virulence and antimicrobial properties in Aeromonas spp. isolated from cockles (Tegillarca granosa) in Korea. Firstly, genomic DNA was extracted from 32 Aeromonas spp. isolates, and PCR screening for virulence, antimicrobial resistance genes was carried out. The disk diffusion assay was used to examine antimicrobial susceptibility. Aeromonas spp. isolates comprised, A. hydrophila (n = 8), A. veronii (n = 15), A. media (n = 2), A. salmonicida (n = 2), A. allosaccharophila (n = 1), A. bestiarum (n = 1), A. culicicola (n = 1), A. enteropelogenes (n = 1) and A. rivipollensis (n = 1). High prevalence of virulence-related genes reported as; act (69%), alt (47%), ast (41%), aerA (56%), lip (50%), ahyB (47%), ser (28%), fla (66%), gcat (44%), ascV (50%) and hlyA (72%). All isolates were multidrug resistant, while highest resistance level observed for ampicillin (100%), followed by imipenem (81%), rifampicin (78%), cephalothin (72%), piperacillin (47%) and Colistin sulfate (31%). The presence of bla_SHV , bla_CTX , tetE, aac(6')-Ib, strA-strB, qnrS, qnrB and IntI1 genes were reported in varying combinations. Nevertheless, bla_TEM , bla_IMP , tetA, tetB, qnrA, qnrB and aphAI-IAB genes and the class1 integron were not detected. The high occurrence of virulence and antimicrobial resistance genes in cockles reveals that it can be a potential health risk source for consumers.

Phylogenetic relationships, virulence and antimicrobial resistance properties of Klebsiella sp. isolated from pet turtles in Korea

Klebsiella sp. are responsible for a multitude of infectious diseases in both humans and animals. In this study, phylogenetic relationships, virulence and antimicrobial resistance gene properties of 16 Klebsiella sp. isolated from 49 pet turtles were investigated. The isolates including Klebsiella oxytoca (n = 13) and Klebsiella pneumoniae (n = 3) were identified using 16S rRNA gene sequencing and each species formed distinct clusters in the neighbour-joining phylogenetic tree. The prevalence of virulence genes including ureC (100%) and kfu (68·75%) was observed among the isolates using Polymerase chain reaction (PCR) assay. The fimH, mrkD and rmpA genes were detected in all K. pneumoniae while these were absent in every K. oxytoca isolate. In antimicrobial susceptibility testing, high resistance rates were observed against ampicillin (100%) and cephalothin (62·50%). The resistance rates against imipenem, tetracycline, trimethoprim/sulfamethoxazole, nalidixic acid and ciprofloxacin were 12·50, 12·50, 12·50, 6·25 and 6·25% respectively. The presence of antimicrobial resistance genes such as plasmid-mediated quinolone resistance (PMQR) [qnrB (37·50%), qnrA (31·25%), qnrS (12·50%) and aac(6')-Ib-cr (12·50%)], extended-spectrum β-lactamase (ESBL) [bla_CTX-M (18·75%)], β-lactamase [bla_SHV-1 (18·75%)] and tetracycline resistance [tetE (12·50%)] was observed. The results revealed that pet turtle-borne Klebsiella sp. may carry different types of virulence and antimicrobial resistance genes which represents a potential threat to public health. SIGNIFICANCE AND IMPACT OF THE STUDY: Klebsiella sp. are nonmotile Gram-negative bacteria that are found in different environments. The virulence and antimicrobial resistance properties of pet turtle-borne Klebsiella sp. have not been studied before. Phylogenetic relationships, virulence traits and antimicrobial resistance profiles of pet turtle-borne Klebsiella sp. were characterized for the first time in Korea. Multiple virulence and antimicrobial resistance genes were observed among the isolates. The occurrence of virulence and antimicrobial resistance determinants in Klebsiella sp. may represent a potential threat to public health.

Manila clam (Ruditapes philippinarum) marketed in Korea as a source of vibrios harbouring virulence and β-lactam resistance genes

The present study assessed the occurrence, virulence determinants and antimicrobial susceptibility patterns of Vibrio spp. isolated from live Manila clam (Ruditapes philippinarum). A total of 31 Vibrio spp. including 27 V. diabolicus, two V. fluvialis, one V. alginolyticus and one V. antiquarius were isolated and identified. Phenotypic detection of DNase, lipase, phospholipase, amylase and caseinase activities was 100%; and 87% gelatinase, 45% slime production and 6% haemolysin activities were also observed. The prevalence of toxin-related virulence genes for collagenase (94%), toxR (100%), tlh (68%), and VPI (71%) was detected by PCR. Additionally, two V. fluvialis isolates carried F-toxR and hupo genes. Moreover, 61% of the isolates showed multiple antimicrobial resistance indices >0·2. The resistance rates of ampicillin, piperacillin, colistin sulfate, rifampicin, and cephalothin were 100, 81, 71, 77 and 68% respectively. The prevalence of blaCTX-M (87%), blaTEM (55%) and Int1 (90%) genes was observed, whereas blaSHV, strA-strB, tetA, tetB, and aadA2 gene cassette were reported in varying combinations. However, armA, aac(3)-IIa and quinolone resistance genes (qnrA, qnrB, qnrS) were not amplified. Thus, the virulence along with extended-spectrum β-lactamases (ESBLs) and other antimicrobial resistance genes in multidrug-resistant Manila clam-borne vibrios may pose a public health threat for consumers. SIGNIFICANCE AND IMPACT OF THE STUDY: In Korea, eating raw seafood is considered a great delicacy. This has negatively affected the public by increasing health issues over the years due to the ingestion of vibrios. For the first time, we could identify Vibrio diabolicus and Vibrio antiquarius in marketed Manila clams in Korea. The prevalent Vibrio diabolicus isolates demonstrated the Vibrio parahaemolyticus and Vibrio cholerae homologous virulence genes (toxR, tlh, and VPI). Additionally, the abundance of extended-spectrum β-lactamases (ESBLs) and integron (IntI1) harboured by Manila clam-borne vibrios elucidate the potential health risk for consumers and may complicate health treatments in the case of infection.

Prevalence of virulence and extended-spectrum β-lactamase (ESBL) genes harbouring Vibrio spp. isolated from cockles (Tegillarca granosa) marketed in Korea

The present study aimed to investigate the incidence, virulence and antibiotic properties in Vibrio spp. isolated from cockles (Tegillarca granosa) marketed in Korea. A total of 32 Vibrio spp. isolates including V. parahaemolyticus (n = 4), V. alginolyticus (n = 11), V. diabolicus (n = 14) and V. harveyi (n = 3) were detected using gyrB sequencing. The phenotypic pathogenicity revealed that the DNase, amylase and phospholipase activities were 100%, while lipase, slime production, gelatinase and caseinase were detected in 72, 88, 88 and 81% of the isolates respectively. The PCR amplification for the detection of V. parahaemolyticus species-specific tdh, tlh, trh and toxR genes were positive in 4 (13%), 16 (50%), 0 (0%) and 4 (13%) isolates respectively. The V. alginolytuicus species-specific tdh, tlh, trh, toxR and vac genes were carried by 15 (47%), 29 (91%), 0 (0%), 15 (47%) and 25 (78%) of the isolates respectively. In addition, multidrug resistance was observed by 27 (84%) isolates, whereas higher resistant rates were observed against ampicillin, piperacillin, streptomycin and cephalothin. The occurrence of bla_CTX (78%), bla_TEM (40%), bla_SHV (22%) and aac(6')-Ib (94%) were prevalent, while strAB, tetB, aphAI-IAB, intl1 and aadA1 gene cassettes were also detected. The results signify the potential health risks resulting from the consumption of raw cockles in Korea. SIGNIFICANCE AND IMPACT OF THE STUDY: Vibrios are well known to cause human infections following consumption of raw or undercooked seafood. This phenomenon has undoubtedly increased the number of health issues over the past few years in Korea. Among the identified Vibrio spp., we could detect V. diabolicus and V. harveyi for the first time in marketed cockles in Korea. The presence of species-specific genes (tdh-VA, tlh-VP, tlh-VA and toxR-VA) in V. diabolicus exhibits the close genetic affinity among V. parahaemolyticus and V. alginolyticus. Furthermore, the prevalence of extended-spectrum β-lactamases (ESBLs) and other antibiotic resistance genes along with multidrug resistance signifies the potential threat for consumers.

Antimicrobial resistance of pathogenic Aeromonas spp. isolated from marketed Pacific abalone (Haliotis discus hannai) in Korea

AIMS

The object of this study was to identify potential health concerns of the Aeromons spp. isolated from marketed Pacific abalone (Haliotis discus hannai) with respect to their virulence and antimicrobial resistance patterns.

METHODS AND RESULTS

We identified 29 strains of aeromonads consisting of five species; Aeromonas hydrophila (n = 9), Aeromonas enteropelogenes (n = 14), Aeromonas veronii (n = 3), Aeromonas salmonicida (n = 2) and Aeromonas sobria (n = 1), by employing series of biochemical tests and gene sequencing. In the phenotypic virulence assays, all isolates showed gelatinase and caseinase activities, while lipase formation (69%), phospholipase production (90%), DNase formation (82%), slime production (49%) and haemolysis activity (α = 18% and β = 82%) were also detected among isolates. Prevalence of virulence genes; aerA (100%), fla (66%), ahyB (73%), act (52%), alt (42%), ast (35%), ser (52%), gcat (69%), ascV (43%), hlyA (83%), lip (52%) and exu (59%) were detected by PCR assays. In disc diffusion test, 100% resistance was detected against ampicillin while cephalothin, rifampicin, oxytetracycline, colistine sulphate, nalidixic acid and piperaciliin were resisted by 86, 73, 42, 35, 28, 20 and 20% of the isolates respectively. Thirteen (45%) of the isolates showed multiple antimicrobial resistance (MAR) indices ≥ 0·2.

CONCLUSIONS

Our findings suggest that the potential health risk posed by the abalone-borne Aeromonas spp. should not be underestimated.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first time to evaluate possible public health risks upon consumption of abalone harbored Aeromonas spp. and also to isolate potential pathogenic and multidrug-resistant Aeromonas spp. from Pacific abalone in Korea.

Occurrence of Virulence and Extended-Spectrum β-Lactamase Determinants in Vibrio spp. Isolated from Marketed Hard-Shelled Mussel (Mytilus coruscus)

This study investigated the occurrence of virulence and antimicrobial resistance properties in Vibrio spp. isolated from hard-shelled mussel (Mytilus coruscus) marketed in Korea. A total of 32 Vibrio spp. isolates including Vibrio diabolicus (n = 16), Vibrio alginolyticus (n = 13), Vibrio parahaemolyticus (n = 2), and Vibrio harveyi (n = 1) were identified by gyrB gene sequencing. Every isolate grouped with their respective reference sequence excluding V. diabolicus and V. alginolyticus that were intermixed in a neighbor-joining phylogenetic tree. Every Vibrio spp. showed DNase and gelatinase activities. Phospholipase, slime, caseinase, lipase, β-hemolysis, and α-hemolysis were positive in 31 (96.8%), 31 (96.8%), 29 (93.5%), 28 (87.5%), 17 (53.1%), and 9 (28.1%) isolates, respectively. The PCR amplification of virulence genes displayed that V. alginolyticus-specific (toxR, tlh, VAC, and VPI) genes were detected in 23 (71.9%), 18 (56.3%), 21 (65.6%), and 26 (81.3%) isolates, respectively. V. parahaemolyticus-specific (toxR and tlh) genes were harbored by 2 (6.3%) and 2 (6.3%) isolates, respectively. The other virulence genes including ctxAB and hupO genes were observed in 23 (71.9%) and 16 (50.0%) isolates, respectively. The antimicrobial resistance was prevalent for amoxicillin (100.0%), ampicillin (100.0%), and streptomycin (37.5%) in disk diffusion test. Multiple antimicrobial resistance index ranged from 0.09 to 0.22. The extended-spectrum β-lactamase (ESBL) genes, blaCTX, blaTEM, blaSHV, and blaOXA were detected in 28 (87.5%), 13 (40.6%), 7 (21.8%), and 1 (3.1%) isolates, respectively. Non-ESBLs such as streptomycin resistance (strA.B), kanamycin resistance (aphA-IAB), and tetracycline resistance (tetE) genes were found in 5 (15.6%), 3 (9.4%), and 1 (3.1%) isolates. Class 1 integron-related Integrase 1 (intI1) gene was found in 8 (25.0%) isolates. Our results reveal that the consumption of raw mussels may cause a potential public health risks owing to the virulent and antimicrobial-resistant Vibrio spp.

Carboxylic acid modified pH-responsive composite polymer particles

pH-responsive polymers are attracting much interest from researchers because of their wide application potentials in areas like biosensor, bioseparator, bioreactor, biocatalysis, drug delivery, and water treatments. In this investigation a two-step process is evaluated to prepare carboxyl(–COOH) functional submicrometer-sized pH-responsive composite polymer particles. First, submicrometer-sized polystyrene (PS) particles are prepared by a modified conventional dispersion polymerization. In the second step, PS/poly(methacrylic acid-acrylamide-ethylene glycol dimethacrylate) [PS/P(MAA-AAm-EGDMA)] composite polymer particles are synthesized by seeded co-polymerization of methacrylic acid, acrylamide, and ethylene glycol dimethacrylate in the presence of PS seed particles. The size distributions and morphologies analyzed by electron micrographs suggested that seeded copolymerization smoothly occurred without formation of any secondary tiny copolymer particles. The surface composition and functionality are confirmed by Fourier transform infrared spectroscopy and proton nuclear magnetic resonance. The hydrodynamic diameter increased with the increase in pH values as part of the carboxyl groups are deprotonated, which favored the swelling of copolymer layer formed around the surface of PS particles. The adsorption of cationic and anionic surfactants at two different pH values showed that adsorption of cationic surfactant is favored at higher pH value whereas that of anionic surfactant is favored at lower pH value.

Antibiotic and heavy metal resistance genes in Aeromonas spp. isolated from marketed Manila Clam (Ruditapes philippinarum) in Korea

AIMS

Manila clam (Ruditapes philippinarum) is one of the most popular seafood in Korea, owing to their unique taste and nutritional value. This study aimed to disclose the antibiotic and heavy metal resistance characteristics of Aeromonas spp. isolated from marketed Manila clam in Korea.

METHODS AND RESULTS

A total of 36 Aeromonas spp. strains were isolated and subjected to two tests: an antibiotic disk diffusion test to determine their resistance to antibiotics, and a broth dilution test to determine their resistance to heavy metals. PCR-based amplification was performed to detect the resistance genes. A high level of resistance to ampicillin (100%) and cephalothin (89%) was observed, while 42, 39, 36 and 36% of the isolates were resistant to oxytetracycline, imipenem, nalidixic acid and tetracycline respectively. In addition, among the tested heavy metals, cadmium (Cd) recorded the highest resistance rate (61%), followed by chromium (Cr) (50%), lead (Pb) (47%) and copper (Cu) (37%). However, mercury (Hg) resistance was not observed. PCRs revealed the occurrence of bla_TEM , bla_SHV , bla_CTX-M , qnrS, tetB, tetE, aac(6')-Ib, strA-strB and intI1 genes among 100, 31, 31, 78, 78, 89, 25, 50 and 72% of the isolates respectively. Moreover, heavy metal resistance genes, copA, merA and czcA were detected in 25, 47 and 61% of the isolates respectively.

CONCLUSIONS

The results suggest the importance of multi-drug and heavy metal-resistant aeromonads in Manila clam to assess the consumer safety and public health.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study is the first to elaborate on the importance of multi-drug and heavy metal-resistant aeromonads in Manila clam. Particularly, the presence of extended-spectrum-β-lactamase genes and other antibiotic resistance genes intensifies the possible health risks and may complicate therapeutic treatments upon infection, while heavy metal resistance suggests possible heavy metal exposure.

Incidence of antimicrobial resistance genes and class 1 integron gene cassettes in multidrug-resistant motile Aeromonas sp. isolated from ornamental guppy (Poecilia reticulata)

Aeromonas sp. are opportunistic pathogenic bacteria which are associated with various diseases in ornamental fish, aquaculture raised species and wild fisheries. In our study, antimicrobial resistance patterns, antimicrobial resistance genes and class 1 integron gene cassettes of 52 guppy-borne Aeromonas sp. were examined. The isolates were identified as A. veronii (n = 34), A. dhakensis (n = 10), A. hydrophila (n = 3), A. caviae (n = 3) and A. enteropelogenes (n = 2) by gyrB gene sequencing. Every isolate was resistant to at least four antimicrobials in disc diffusion test. The resistance to amoxicillin, nalidixic acid and oxytetracycline was 100% among the tested isolates. 92·30, 76·92, 71·15, 51·92, 51·92 and 50·00% of the isolates were resistant to ampicillin, rifampicin, imipenem, cephalothin, tetracycline and trimethoprim respectively. The multiple antibiotic resistance index values ranged from 0·28 to 0·67. PCR amplification of antimicrobial resistance genes implied the occurrence of tetracycline resistance (tetA (65·39%), tetE (25·00%) and tetB (15·38%)), plasmid-mediated quinolone resistance (qnrS (26·92%) and qnrB (17·31%)) and aminoglycoside resistance (aphaAI-IAB (7·69%) and aac (6')-Ib (3·84%)) genes in the isolates. The IntI gene was positive for 36·54% of the isolates and four class 1 integron gene cassette profiles (aadA2, qacE2-orfD, aadA2-catB2 and dfrA12-aadA2) were identified. These data suggest that ornamental guppy can be a reservoir of multidrug-resistant Aeromonas sp. which comprise different antimicrobial resistance genes and class 1 integrons. SIGNIFICANCE AND IMPACT OF THE STUDY: Antimicrobial resistance genes and integron gene cassettes of ornamental fish-borne aeromonads are poorly studied. The antimicrobial resistance patterns, antimicrobial resistance genes and class 1 integron gene cassettes of Aeromonas sp. isolated from ornamental guppy were characterized for the first time in Korea. The incidence of different antimicrobial resistance genes and class 1 integron gene cassettes were observed in multidrug-resistant Aeromonas isolates. This result suggests that better management practices are necessary to prevent and address the serious consequences of indiscriminate and inappropriate antimicrobial use, and the distribution of multidrug-resistant bacteria.

Characterization of Quinolone-Resistant Determinants in Tribe Proteeae Isolated from Pet Turtles with High Prevalence of qnrD and Novel gyrB Mutations

Development of antibiotic resistance in bacteria has challenged significantly in both veterinary and human medicine. In this study, we analyzed the potential risk of pet turtles harboring tribe Proteeae as a source of quinolone-resistant determinants, including plasmid-mediated quinolone resistance (PMQR) genes and target gene alterations in the quinolone resistance-determining region (QRDR). Antimicrobial susceptibility of 54 Proteeae isolates against ciprofloxacin, ofloxacin, levofloxacin, and nalidixic acid was examined. The PMQR genes and QRDR alterations were identified using conventional PCR assays and sequencing. Four isolates were resistant to all quinolones tested in this study. Nine isolates showed resistance to nalidixic acid and showed either intermediate resistance or susceptibility to other tested quinolones. All isolates resistant to one or more tested quinolones harbored mutations in gyrB and some also had gyrA and parC mutations. Of 54, 12 Proteeae isolates displayed the novel E466D, N440T, Q411S, and F417L mutations in gyrB. Among the PMQR genes, 41 (76%) isolates harbored the qnrD gene with the highest prevalence, whereas aac(6')Ib-cr, qnrS, qnrA, and qnrB genes were detected in 28 (52%), 9 (17.0%), 7 (13.0%), and 1 (1.9%) study isolates, respectively. The QRDR analysis of selected mutants revealed that increasing quinolone selective pressure led to a predominance of gyrA mutants. All results indicate that a healthy pet turtle can play as a potential reservoir for quinolone-resistant Proteeae, which it might cause public health risk on pet owners.

Incidence of antibiogram, antibiotic resistance genes and class 1 and 2 integrons in tribe Proteeae with IMP27 gene for the first time in Providencia sp. isolated from pet turtles

Proteeae is a tribe which consists of three genera: Proteus, Providencia and Morganella. The objective of this study was to determine antimicrobial resistance profile, virulence genotype and class 1 and 2 integrons in Proteeae isolated from pet turtles and to determine the impact of antibiotic resistance on virulence and antimicrobial resistance genes. Integron-positive isolates were used to detect their gene cassette array. Sixty four Proteeae were isolated and all were resistant to macrolides (100%). Among 64 isolates 56, 52, 36 and 25 were resistant to nitrofurans, β-lactams, tetracycline and aminoglycoside respectively. Sixteen (25%) isolates were positive for intI1 while 14 (21·87%) were positive for integrase 2 (intI2). Eleven (17·18%) isolates were positive for class 1 variable region while 7 (10·93%) were positive for class 2 variable region. IMP27, a novel metallo β-lactamase gene was found in Providencia isolates. Proteus sp. were positive for every tested virulence genes and UreC gene was detected in 48·44% followed by zapA (17·19%), mrpA (17·19%) and hlyA (14·06%) genes. In this study, integron associated-antibiotic resistance genes have been identified in Proteeae isolates in a considerable range representing clear threats to public health. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study, multidrug-resistant Proteeae isolates had several antibiotic resistance genes. Integrons are important contributors to the development and dissemination of antibiotic resistance. We could detect both class 1 and 2 integrons and several gene cassette arrays in class 1 integron. The gene cassette arrays of the Class 2 integrons contained IMP27-dfrA1-aadA1-catB2-ybeA-ybgA in two isolates. To the best of our knowledge this is the first study to report detection of IMP27 in Providencia rettgeri isolates. All results indicate that healthy pet turtles act as potential reservoirs for Proteeae species with zoonotic potential.