Molecular Epidemiology of HIV-1 Subtypes and Primary Antiretroviral Resistance Profiles in Northern Cyprus: First Data Series

The distribution of human immunodeficiency virus-1 (HIV-1) subtypes indicates difference from region to region and in risk groups acquiring the disease worldwide. Although subtype C is more in terms of total cases, subtype B is dominant in certain regions, especially in western and central Europe. Molecular epidemiological studies are essential for the control, effective treatment, and understanding in transmission routes of HIV-1 infection. This study aims to determine the molecular epidemiology and antiretroviral drug resistance profiles of HIV-1 in northern Cyprus. The study involved 71 naive HIV-positive patients diagnosed in northern Cyprus between 2016 and 2022. HIV-1 subtypes and circulating recombinant forms (CRFs) were identified by phylogenetic analysis (neighbor-joining method) of pol gene sequences. Drug resistance mutations were analyzed using the World Health Organization (WHO) lists of mutations for surveillance. The Stanford University HIVdb program was used to interpret drug resistance mutations. In our study, 40 of 71 samples were successfully sequenced. Subtype B of HIV-1 was dominant with a rate of 52.5%, followed by CRF02_AG (20%) and G (7.5%) subtypes. The rate of subtype B (71.4%) in northern Cyprus was significantly higher than in the other country of origin (p = .028). Antiretroviral drug resistance was found in 15% of the sequenced serum samples. Nucleoside/nucleotide reverse transcriptase inhibitor (NRTI), non-nucleoside nucleotide reverse transcriptase inhibitor (NNRTI), and protease inhibitor (PI) resistance rates were 10% (4/40), 7.5% (3/40), and 2.5% (1/40), respectively. According to the results, it is noteworthy that the dominant subtype circulating in northern Cyprus is the B subtype, and CRFs were detected at a higher rate than expected.

Determination of the cryoprotective effect of n-methylacetamide in rabbit semen

BACKGROUND

Amides are low molecular weight cryoprotectants. N-methylacetamide (MA) is one of the cryoprotectant agents in this group.

OBJECTIVE

To investigate the cryoprotective effect of MA in rabbit semen.

MATERIALS AND METHODS

For this purpose, six ejaculates from six New Zealand rabbits were collected and pooled using an artificial vagina. Pooled semen was divided into four equal parts and diluted with TCG+ egg yolk. CPA was added to form the following groups: Control with 6% DMSO; Group 1 with 1% MA; Group 2 with 2% MA; and Group 3 with 3% MA. After the addition of CPA, the semen eqilibration procedure was started. Sperm were then drawn into 0.25 mL straws, frozen by automatic semen freezing and stored in a liquid nitrogen container. Pipettes were thawed after 24 h and analyses were performed.

RESULTS

Total, progressive and rapid motility values of the Control group were higher than those of the MA groups (p<0.05). However, there was no statistical difference between the Control and Group 2 in terms of these parameters. While there was no statistical difference between the groups in terms of acrosome damage and mitochondrial membrane potential, the best results were observed in Control, Group 2, Group 1 and Group 3, respectively. When we compared all groups, no difference was found in terms of MDA, CAT and GSH-Px. There was a statistical difference between Group 3 and the Control in terms of GSH level (p<0.05).

CONCLUSION

DMSO appeared to be more useful for the cryopreservation of rabbit semen compared to MA. Doi.org/10.54680/fr23610110812.

Sex and ABO Blood Differences in SARS-CoV-2 Infection Susceptibility

Data consisting of millions of cases cannot still explain the immunopathogenesis mechanism between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and host cell for ongoing coronavirus disease 2019 (COVID-19) pandemics. Epidemiological studies among different populations suggested different impacts of ABO and Rh antibodies on the COVID-19 susceptibility. Thus, the ABO blood group and the SARS-CoV-2 infection paradox remain unclear. Therefore, the present retrospective case-control study aimed to investigate the possible association between ABO blood groups and Rh blood types on SARS-CoV-2 infection in the Turkish Cypriot population. A total of 18,639 Turkish Cypriot subjects (297 SARS-CoV-2 COVID-19 patients and 18,342 healthy) were included in this study. Personal and clinical characteristics including age, gender, SARS-CoV-2 infection status, the ABO blood group and Rh blood types were evaluated and compared between two groups. As a result, ABO blood group was shown to be associated with a higher risk of SARS-CoV-2 infection as well as with male sex ( p  = 0.018). There was no association between Rh blood type and COVID-19. Overall, this study is the first largest sample group study to show the distribution of ABO blood group and Rh blood types in the healthy Turkish Cypriot population. Based on the current evidence, there are insufficient data to guide public health policies regarding COVID-19 pathogenesis.

The prophylactic efficacy of Anatolian propolis in individuals at high risk of COVID-19

OBJECTIVE

No prophylactic treatment is available for individuals at high risk of developing COVID-19. This study, which was conducted between December 25, 2020, and January 25, 2021, is one of the first clinical studies to evaluate the efficacy of Anatolian propolis supplement against COVID-19. The aim was to obtain evidence on the prophylactic use of Anatolian propolis in individuals at high risk of developing COVID-19.

SUBJECTS AND METHODS

This volunteer-based study was conducted in two centers. The study involved 209 healthcare professionals (physicians, nurses, medical secretaries) from Emergency Medicine Department of Medical Faculty of Ataturk University and Emergency Medicine Department of Rize Recep Tayyip Erdogan University. 204 participants meeting the study criteria were divided into two groups as experimental group and control group. The experimental group received 20 drops of BEE'O UP (BEE&YOU) 30% Propolis drops twice a day during a follow-up period of 1 month. The control group received no supplement but was followed up. The participants showing symptoms during the study and all the participants at the end the study were subjected to PCR testing.

RESULTS

The evaluation of the results of PCR testing at the end of the study has shown that 14 participants from the control group and only 2 participants from the experimental group, who received Anatolian propolis supplement, were reported as positive cases.

CONCLUSIONS

It has been found that a statistically significant protection was induced against COVID-19 infection in 98% of the experimental group, who received Anatolian propolis, compared to the control group.

Detection of SARS-CoV-2 N501Y mutation among SARS-CoV-2 variants of concern circulating in Northern Cyprus

Aim: SARS-CoV-2 variants of concern (VOCs) carry signature mutations particularly in the spike protein. Most VOCs lineages that carry N501Y substitution have been reported to evade viral diagnostic tests and have impact on vaccine effectiveness. Therefore, monitoring the circulating variants represents a major requirement for a public health response worldwide. We aimed to investigate the prevalence of N501Y bearing SARS-CoV-2 samples in Northern Cyprus. Materials & methods: Reverse transcription quantitative PCR technique was used to identify N501Y mutation from 658 samples. Results: Our results indicate that the proportion of N501Y-bearing lineages increased significantly from January through May 2021 (45.2–75.5%) in the region. Conclusion: These results indicate that VOCs are dominant lineages in the country and highlight an alarming situation which require strict governmental measures to minimize COVID-19 morbidity and mortality.

The role of three dimensional transesophageal echocardiography novel score in the success of redo percutaneous mitral balloon valvuloplasty

Funding Acknowledgements

Type of funding sources: None.

Background

Mitral valve morphology is traditionally evaluated according to the images of two-dimensional transthoracic echocardiography and Wilkins score (WS) criteria in the selection of suitable patients for Percutaneous balloon mitral valvuloplasty (PBMV).  However, WS does not include mitral commissural morphology, it is known that not only WS but mitral valve commissure morphology is also important in the success of PBMV. It is known that mitral stenosis might develop secondary to the progression of the disease in the follow-up of the patients after first PBMV, and there are a limited knowledge about outcome and success in terms of redo PBMV.

Purpose

We aimed to determine whether WS in redo PMBV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure.

Methods

Our study designed as a retrospective, single center study. Fifty patients who underwent redo PMBV were included in the study. The patients were divided into two groups according to the success of the Redo PMBV procedure which was defined as post-procedural Mitral valve area (MVA) ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation immediately after Redo PMBV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PMBV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated.

Results

In the study group, 36 patients (72%) had successful redo PMBV procedure. WS was 8 (IQR 7 - 9) and novel 3D TEE score was found 4 (IQR 3 - 4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). According to these findings; when both models were compared, the predictive accuracy and performance of the model developed with novel 3D TEE score to predict procedural success was found to be more favorable than the model developed with WS. When the probability of procedural success was calculated according to novel 3D TEE score using univariable logistic regression analysis, the probability of procedural successes was calculated &gt; 90%, especially when novel 3D TEE score was &lt;4. 

Conclusion

The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PMBV, especially in patients who are considered for surgery due to the high WS. Abstract Figure. Definition of novel 3D TEE scoring  Abstract Figure. Information about novel 3D TEE scoring

Antibiotic resistance rate of the Methicillin Resistant Staphylococcus aureus isolated from a university affiliated hospital in North Cyprus

Background: Over the past 20 years, studies have indicated that the increasing spread of methicillinresistant Staphylococcus aureus (MRSA) demonstrates the need for adequate information about their epidemiology. This study was conducted in order to investigate the resistance rate of MRSA which were isolated from the Near East University (NEU) Hospital, North Cyprus. Methods: MRSA was isolated and identified by using selective media and the Phoenix BD 100 system (software version 6.01A) was used for antimicrobial susceptibility testing and identification. The antimicrobial susceptibility results were determined according to the Clinical and Laboratory Standarts Institute (CLSI) and the resistance rates of MRSA isolates to antibiotics were examined retrospectively. Results: The highest number of samples were from the departments of chest disease (24%) followed by dermatology (21.3%) and cardiology (18.7%). Out of 75 MRSA strains,; 29.7% from blood, 25.3% from wound, 14.7% from nasal swabs, 10.7% from aspiration fluids, 9.3% from sputum, 6.7% were from urine, 4.0% from IV catheters culture samples. All strains of MRSA were 94.7% sensitive to vancomycin and teicoplanin. Conclusions: The obtained results revealed that preventative measures should be implemented in order to minimize the bacterial resistance to antibiotics. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 101-104

Genetic characterisation of antibiotic resistance transposons Tn6608 and Tn6609 isolated from clinical Pseudomonas strains in Cyprus

OBJECTIVES

Antibiotic therapy for Pseudomonas infections is becoming increasingly difficult. In this study, the transposons from two multidrug-resistant (MDR) clinical Pseudomonas strains containing related transposons responsible for giving rise to resistance determinants were characterised.

METHODS

Two MDR clinical Pseudomonas isolates were obtained from a medical facility in Cyprus. The strains were identified as Pseudomonas putida C54 and Pseudomonas aeruginosa C69. DNA was extracted from both strains and was sequenced. Transposons were identified, annotated and compared with DNA sequences in GenBank.

RESULTS

Two related nested transposons, here named Tn6608 (from P. putida C54) and Tn6609 (from P. aeruginosa C69), were characterised. The transposons are built on an ancestral Tn1403 base element (here named Tn1403A) that contains only the transposition module (tnpA and tnpR) and the associated cargo gene module (orfA, orfB, orfC and orfD) flanked by a 38-bp inverted repeat. The nested transposons identified in this study have evolved via acquisition of multiple transposons, adding multiple resistance genes to an ancestral transposon that originally lacked any resistance determinants.

CONCLUSION

Transposons related to Tn6608 and Tn6609 have evolved and are globally disseminated. Of particular interest is that most of these nested transposons are located within the same site in a genomic island, providing alternative avenues for dissemination.

Big Concern for Public Health: Microbial Contamination of Mobile Phones

INTRODUCTION

Mobile phones are dynamic source of microorganisms in households and professional settings. The aim was to determine the prevalence of bacterial contamination of the mobile phones, identify bacterial isolates, assess their antimicrobial susceptibility patterns and define the efficiency of using disinfectant.

METHODOLOGY

This study included 233 dental students from Near East University, Faculty of Dentistry. Swab samples taken from mobile phones before and after disinfection were inoculated onto 5% sheep blood medium and eosin methylene blue medium and incubated aerobically at 37°C for 24-48 hours. Mold-growing mix cultures were sub-cultured on the sabouraud dextrose medium and allowed to grow at room temperature. Conventional microbiological techniques and VITEK 2 automated identification system were used for bacterial identification and antimicrobial susceptibility testing. Antibiotic susceptibility tests were verified by Kirby-Bauer disc diffusion technique according to the European Antimicrobial Susceptibility Test Committee criteria. Mold colonies were identified macroscopic and microscopically according to their phenotypic properties using lacto-phenol cotton blue stain.

RESULTS

Microbial contamination of mobile phones was 81% (120.953 cfu/ml) in swab samples taken without using alcohol-based wipes however, microbial contamination in swab samples taken after one-time disinfection was determined to be 21% (201 cfu/ml). The most common microorganisms isolated were coagulase negative Staphylococci (69%) and Aspergillus niger (13%). All of the isolated bacteria were susceptible to all antibiotics used.

CONCLUSIONS

This study represents the first data on the rate of microbial contamination on mobile phones in Northern Cyprus and the efficiency of the use of alcohol to disinfect the mobile phones.

Automated detection of Mycobacterium tuberculosis using transfer learning

INTRODUCTION

Quantitative analysis of Mycobacterium tuberculosis using microscope is very critical for diagnosing tuberculosis diseases. Microbiologist encounter several challenges which can lead to misdiagnosis. However, there are 3 main challenges: (1) The size of Mycobacterium tuberculosis is very small and difficult to identify as a result of low contrast background, heterogenous shape, irregular appearance and faint boundaries (2) Mycobacterium tuberculosis overlapped with each other making it difficult to conduct accurate diagnosis (3) Large amount of slide can be time consuming and tedious to microbiologist and which can lead to misinterpretations.

METHODOLOGY

To solve these challenges and limitations, we proposed an automated-based detection method using pretrained AlexNet to trained the model in 3 sets of experiments A, B and C and adjust the protocols accordingly. We compared the detection of tuberculosis using AlexNet Models with the ground truth result provided by microbiologist and analyzed inconsistencies between network models and human.

RESULTS

98.15 % accuracy, 96.77% sensitivity and 100% specificity for experiment A, 98.09% accuracy, 98.59% sensitivity and 97.67% specificity for experiment B and 98.73% testing accuracy, 98.59 sensitivity, 98.84% specificity ofr experiment C which sound robust and promising.

CONCLUSIONS

The results indicated that network performance was successful with high accuracies, sensitivities and specificities and it can be used to support microbiologist for diagnosis of tuberculosis.

Prevalence of Panton-Valentine leukocidin in methicillin-resistant Staphylococcus aureus clinical isolates at a university hospital in Northern Cyprus: a pilot study

Objective

Panton-Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA) is a healthcare problem worldwide. There are no reports on the virulence characteristics of MRSA in Northern Cyprus (NC). This study aimed to determine the presence of pvl among MRSA isolates from patients admitted to a university hospital in NC using molecular methods. Fifty S. aureus strains were included in this study. BD Phoenix automated identification system was used for bacterial identification and antibiotic susceptibility testing. Methicillin resistance was confirmed by disc diffusion assay. Presence of nuc and mecA genes was tested by multiplex PCR. Detection of pvl gene was performed by single-target PCR.

Results

Out of 50 S. aureus isolates identified as MRSA by BD Phoenix system, 3 were susceptible to cefoxitin with disc diffusion assay and were confirmed as methicillin-sensitive S. aureus (MSSA). All isolates (n = 50, 100%) tested positive for the presence nuc gene and 68% (n = 34/50) were mecA positive. pvl was detected in 27.7% (n = 13/47) of the MRSA isolates. Among PVL-positive MRSA isolates, 69.2% (9/13) were inpatients. PVL-MRSA was more common in isolates from deep tracheal aspirate (30.8%, 4/13) and abscess/wound (23.1%, 3/13). This represents the first study of PVL presence among MRSA in hospital setting in NC.

Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus

Background

Antibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i) Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC β-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant Enterobacteriaceae (CIP-RE), and (iv) carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE) in Northern Cyprus.

Methods

A total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance.

Results

Of 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively. Escherichia coli was the most commonly recovered species among Enterobacteriaceae isolates. A significant proportion of ESBL-producing E. coli isolates (n = 22/107; 20.6%) was found to be co-resistant to CIP (p = 0.000, OR 3.21, 95% CI 1.76-5.87). In this study, higher socioeconomic status (CIP-RE: p = 0.024, OR 1.96, 95% CI 1.09-3.53), presence of gastrointestinal symptoms (CIRE: p = 0.033; OR 6.79, 95% CI 1.34-34.39), antibiotic use (ESBL-E: p = 0.031; OR 1.67, 95% CI 1.04-2.67; and CIRE: p = 0.033; OR 6.40, 95% CI 1.16-35.39), and travelling abroad (pAmpC-E: p = 0.010; OR 4.12, 95% CI 1.45-11.66) were indentified as risk factors.

Conclusion

The study indicates that resistant Enterobacteriaceae isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.

Acylation Reaction of Polystyrene with Organic Anhydrides and Investigation of the Physico-Mechanical Properties

<p>The acylation reaction of polystyrene with organic anhydrides, such as maleic and ace-tic anhydrides were investigated in the presence of cationic catalysis (AlCl₃, BF₃·O(C₂H₅)₂, FeCl₃, SnCl₄, TiCl₄, ZnCl₂), to synthesise some polyfunctional (carbonyl-, carboxyl-, keto-, olefinic) polystyrene. The incorporation of functional groups to polystyrene were caused an increase of adhesion capability, physico-mechanical properties, elasticity and photosensitivity polyfunctional product.</p>

High Emergence of ESBL-Producing E. coli Cystitis: Time to Get Smarter in Cyprus

Background: Widespread prevalence of extended-spectrum βeta-lactamase producing Escherichia coli (ESBL-producing E. coli) limits the infection therapeutic options and is a growing global health problem. In this study our aim was to investigate the antimicrobial resistance profile of the E. coli in hospitalized and out-patients in Cyprus.

Results: During the period 2010–2014, 389 strains of E. coli were isolated from urine samples of hospitalized and out-patients in Cyprus. ESBL-producing E. coli, was observed in 53% of hospitalized and 44% in out-patients, latest one being in 2014. All ESBL-producing E. coli remained susceptible to amikacin, carbapenems except ertapenem (in-patients = 6%, out-patients = 11%).

Conclusion: High emerging ESBL-producing E. coli from urine samples in hospitalized and out-patients is an extremely worrisome sign of development of untreatable infections in the near future on the island. We therefore emphasize the immediate need for establishment of optimal therapy guidelines based on the country specific surveillance programs. The need for new treatment strategies, urgent prescription habit changes and ban of over-the-counter sale of antimicrobials at each segment of healthcare services is also discussed in this research.

Impact of valve surgery on serum osteopontin levels in patients with mitral regurgitation

OBJECTIVE

Osteopontin (OPN), a sialoprotein present within atherosclerotic lesions, especially in calcified plaques, is linked to the progression of coronary artery disease and heart failure. We assessed the impact of valve surgery on serum OPN and left ventricular (LV) function in patients with mitral regurgitation (MR).

METHODS

Thirty-two patients with severe MR scheduled for surgery were included in the study. Echocardiography markers were assessed preoperatively and at 3 months following the surgery and matched with the serum OPN levels.

RESULTS

Valve surgery was associated with a reduction of the ejection fraction (EF) from 55.2 ± 6.3 to 48.8 ± 7.1% after surgery, p < 0.001. Following surgery, the OPN level was significantly higher than preoperatively (mean 245, range 36-2,284 ng/ml vs. 76, 6-486 ng/ml, p = 0.007). Preoperative OPN exhibited a slight negative correlation with the EF (r = -0.35, p = 0.04), and a moderate correlation with vena contracta (r = -0.38, p = 0.02). There were no other meaningful correlations between conventional echocardiographic parameters and OPN.

CONCLUSION

Following valve surgery due to severe MR, patients exhibited a decrease in EF and an increase in OPN levels. The assessment of preoperative OPN failed to strongly predict probable LV dysfunction.

Gold nanoparticle loaded phytosomal systems: synthesis, characterization and in vitro investigations

A novel liposomal formulation was synthesized by encapsulating both gold nanoparticles (AuNPs) andCalendula officinalisextract as AuNP-phytosomes and AuNP-phytosomes were characterized and used atin vitroinvestigations.

Hallermann-Streiff syndrome with hemihypertrophy

We report on a five year old girl with Hallermann-Streiff syndrome and hemihypertrophy. Hemihypertrophy does not appear to have ever been associated with Hallermann-Streiff syndrome.

Hepatitis A seroprevalence and its relationship with environmental factors in children of different age groups in Kahramanmaras, Eastern Mediterranean region of Turkey

Hepatitis A infections are influenced by environmental and socioeconomic factors. Epidemiologic studies regarding hepatitis A virus (HAV) infection in Turkey have not previously examined these factors. We investigated HAV seroprevalence and its association with sociodemographic factors among children of various ages in the Eastern Mediterranean region of Turkey. The study included 1142 children (603 male and 539 female) between ages of 6 months and 18 years. Seropositivity in the whole group was 57.2%. HAV prevalence rates according to age groups were as follows: 35.5% in 6-23 months group, 19.2% in 2-5 years group, 74.3% in 6-10 years group, 83.0% in 11-14 years group, 92.8% in 15-18 years group. Risk factors that influenced seropositivity were; dense population, over-crowded families, excessive number of siblings, low socioeconomic status and low education of the mother. As HAV seroprevalence in children older than 6 years of age is high, we recommend hepatitis A vaccination in this region after the first year of life.