A global metagenomic map of urban microbiomes and antimicrobial resistance

We present a global atlas of 4,728 metagenomic samples from mass-transit systems in 60 cities over 3 years, representing the first systematic, worldwide catalog of the urban microbial ecosystem. This atlas provides an annotated, geospatial profile of microbial strains, functional characteristics, antimicrobial resistance (AMR) markers, and genetic elements, including 10,928 viruses, 1,302 bacteria, 2 archaea, and 838,532 CRISPR arrays not found in reference databases. We identified 4,246 known species of urban microorganisms and a consistent set of 31 species found in 97% of samples that were distinct from human commensal organisms. Profiles of AMR genes varied widely in type and density across cities. Cities showed distinct microbial taxonomic signatures that were driven by climate and geographic differences. These results constitute a high-resolution global metagenomic atlas that enables discovery of organisms and genes, highlights potential public health and forensic applications, and provides a culture-independent view of AMR burden in cities.

Informed consent should be obtained from patients to use products (skin substitutes) and dressings containing biological material

BACKGROUND

Biological products (tissue engineered skin, allograft and xenograft, and biological dressings) are widely used in the treatment of burns, chronic wounds, and other forms of acute injury. However, the religious and ethical issues, including consent, arising from their use have never been addressed in the medical literature.

AIMS

This study was aimed to ascertain the views of religious leaders about the acceptability of biological products and to evaluate awareness among healthcare professionals about their constituents.

METHODS

The religious groups that make up about 75% of the United Kingdom population were identified and a questionnaire on 11 biological products was sent to its leaders. Another questionnaire concerning 17 products (11 biological and 6 synthetic dressings) was sent to 100 healthcare professionals working in seven specialist units in the UK.

RESULTS

All religious leaders (100% response rate) replied, some after consultation with international bodies. Among them, 77% said that patients should be informed of the constituents of the biological products and consent obtained. Some leaders expressed concerns about particular products including the transmission of viral and prion diseases, cruelty to animals, and material derived from neonates. None of the healthcare professionals (73% response rate) surveyed knew the constituents of all the products correctly.

CONCLUSION

Ignoring religious sensitivities and neglecting consent in the usage of biological products could have very serious implications, including litigation. Hospitals and manufacturers should take immediate measures to enlighten healthcare professionals of the constituents of these products so that they can obtain informed consent from patients.

The load-bearing characteristics of the forearm: pattern of axial and bending force transmitted through ulna and radius

A biomechanical study was performed on 12 cadaveric arms to define the normal profiles of force transmission through the ulna and radius and demonstrate the effect on these of simulated injury of the distal radioulnar joint (DRUJ). Strain gauges were used to measure the axial and bending forces transmitted through each bone. Axial force transmitted through the ulna is, broadly, reciprocal to that seen in the radius, with the greatest force seen in supination. In all 12 arms, axial loading of the hand created an anterior bending force (to create a posterior convexity) in the distal radius. Axial loading of the hand created an anterior bending force in the distal ulna for half the specimens and a posterior bending force in the remaining half. Division and division with reconstruction of either the volar or the dorsal distal radioulnar ligament (DRUL) had no significant effect on force transmission through the ulna and radius, while excision of the ulnar head significantly disrupted the profiles of the axial and bending forces.

Implications for Burns Unit design following outbreak of multi-resistant Acinetobacter infection in ICU and Burns Unit

We reviewed the emergence of 13 cases of multi-resistant Acinetobacter infection in burns patients over a 12-month period. The outbreak was started in a non-burn patient in the intensive care unit (ICU) that spread to burns patients in ICU and then the Burns Unit. The importance of opportunistic infection, potential risk factors, treatment and clinical outcome of Acinetobacter infection in burns patients from this cluster of cases is described. This paper implicates the movement of burns patients and medical equipment between ICU and the Burns Unit in the spread of this infection. Future design of Burn Units should aim to incorporate features to allow the management of all burns cases in one location with all intensive care, burns and theatre facilities built in close proximity.

The effect of elbow position on the range of supination and pronation of the forearm

A kinematic study was performed to examine the influence of elbow position on the range of supination and pronation of the forearm. The ranges of supination and pronation were measured in 50 volunteers (25 men and 25 women) using a custom-designed jig which constrained unwanted and confounding movements of the limb. Measurements were taken with the elbow in full extension, 45 degrees flexion, 90 degrees flexion and full flexion. The data showed a reciprocal relationship between the range of supination and the range of pronation of the forearm which depended on the degree of elbow flexion. As the elbow is flexed, the maximum angle of supination increases while the maximum angle of pronation decreases (p<0.001). The converse is true as the elbow is extended (p<0.001).

Development and validation of chemometrics-assisted spectrophotometric and liquid chromatographic methods for the simultaneous determination of two multicomponent mixtures containing bronchodilator drugs

Three methods are developed for the determination of two multicomponent mixtures containing guaiphenesine (GU) with salbutamol sulfate (SL), methylparaben (MP) and propylparaben (PP) [mixture 1]; and acephylline piperazine (AC) with bromhexine hydrochloride (BX), methylparaben (MP) and propylparaben (PP) [mixture 2]. The resolution of the two multicomponent mixtures has been accomplished by using numerical spectrophotometric methods such as partial least squares (PLS-1) and principal component regression (PCR) applied to UV absorption spectra of the two mixtures. In addition HPLC method was developed using a RP 18 column at ambient temperature with mobile phase consisting of acetonitrile-0.05 M potassium dihydrogen phosphate, pH 4.3 (60:40, v/v), with UV detection at 243 nm for mixture 1, and mobile phase consisting of acetonitrile-0.05 M potassium dihydrogen phosphate, pH 3 (50:50, v/v), with UV detection at 245 nm for mixture 2. The methods were validated in terms of accuracy, specificity, precision and linearity in the range of 20-60 microg ml(-1) for GU, 1-3 microg ml(-1) for SL, 20-80 microg ml(-1) for AC, 0.2-1.8 microgml(-1) for PP and 1-5 microg ml(-1) for BX and MP. The proposed methods were successfully applied for the determination of the two multicomponent combinations in laboratory prepared mixtures and commercial syrups.

Recurrent pleomorphic adenoma of the palate in a child

A rare case of recurrent pleomorphic adenoma of the palate in a 9-year-old boy is presented. Pleomorphic adenoma is relatively rare in children compared with its incidence in adults. However, it is the most common benign epithelial tumour of the salivary glands. The majority of pleomorphic adenomata in children occur in the major salivary glands, mainly the parotid gland. Pleomorphic adenomata of the minor salivary glands are rare in children and mainly occur in the palatal glands. Of the few cases of pleomorphic adenoma of the palate reported in children, only one case showed recurrence of the tumour after primary excision. We present the second case of recurrent pleomorphic adenoma of the palate in a child.

Contact area inside the distal radioulnar joint: effect of axial loading and position of the forearm

BACKGROUND

A biomechanical study was performed to define the normal profiles of contact area inside the distal radioulnar joint and how these profiles change as a result of damage to the distal radioulnar ligaments.

METHODS

Twelve cadaver arms were used and a custom-made jig was designed to allow axial loading of the hand. Tekscan sensor film was used to measure the contact area inside the joint. Measurements were taken with different loads and in different positions of the forearm. The same measurements were taken after dividing either the volar or dorsal distal radioulnar ligament. Finally the measurements were repeated after reconstruction of the divided ligament.

FINDINGS

The contact area increases with axial loading of the hand and is greater in supination than pronation. Division of a single distal radioulnar ligament increases the contact area inside the distal radioulnar joint (123% of normal) and reconstruction of the divided distal radioulnar ligament restores the contact patterns towards the normal values (113% of normal).

INTERPRETATION

The results show that axial loading of the hand and position of the forearm has a significant effect on the contact area inside the distal radioulnar joint. The study also shows that injury of the distal radioulnar ligament disturbs the normal profiles of contact.

Validation and Application of Chemometrics-Assisted Spectrophotometry and Liquid Chromatography for Simultaneous Determination of Two Ternary Mixtures Containing Drotaverine Hydrochloride

Three methods were developed for the determination of two ternary mixtures containing drotaverine hydrochloride (DR) with caffeine and paracetamol (mixture 1) and DR with metronidazole and diloxanide furoate (mixture 2). The first method depends on HPLC separation on an RP C18 column at ambient temperature with the mobile phase methanolwater, pH 3.1 (50 + 50, v/v) and UV detection at 213 nm for mixture 1, and the mobile phase acetonitrile25 mM potassium dihydrogen phosphate, pH 4.6 (55 + 45, v/v) with UV detection at 235 nm for mixture 2. The other two chemometric methods applied were partial least squares (PLS-1) and principal component regression (PCR). These approaches were successfully applied to quantify the five drugs in two ternary mixtures using information included in the UV absorption spectra of appropriate solutions in the wavelength range of 210300 nm with 1 nm intervals. Calibration of PCR and PLS-1 models was evaluated by internal validation (prediction of compounds in its own designed training set of calibration), by cross-validation (obtaining statistical parameters that show the efficiency for a calibration fit model), and by external validation (using laboratory-prepared mixtures and pharmaceutical preparations). The proposed methods were successfully applied for the determination of the two ternary combinations in laboratory-prepared mixtures and commercial tablets; the results of PLS-1 and PCR methods were compared with the HPLC method, and a good agreement was found.

Green ultra-fast high-performance liquid chromatographic method using a short narrow-bore column packed with fully porous sub-2 μm particles for the simultaneous determination of selected pharmaceuticals as surface water and wastewater pollutants

Fast separations are very desirable in laboratories that analyze large numbers of samples per day or those needing short turn-around times. Traditional HPLC methods using conventional stationary phases and standard column dimensions require significant amounts of organic solvents and generate large volumes of waste. With growing awareness about the environment, the development of green technologies has been receiving increasing attention. In this work, a very fast green analytical method based on LC-UV using a short narrow bore column packed with fully porous sub-2 μm particles has been developed for simultaneous determination of nine pharmaceuticals in wastewater and surface water. The chromatographic separation was optimized in order to achieve short analysis time and good resolution for all analytes in a single run. All analytes could be separated in 1 min with good resolution. Sample preparation was executed by solid phase extraction using Oasis HLB cartridges. The method developed was validated based on parameters such as linearity, precision, accuracy, detection, and quantification limits. The recovery ranged from 70.9 to 92.5% with SDs not higher than 5.4%, except for acetaminophen and sulphanilamide. LODs ranged from 0.6-2.5 μg/L, while the LOQs were in the range 2-8 μg/L.

Usage Patterns of Cosmetic and Personal Care Products among Female Population in Saudi Arabia: Important Factors for Exposure and Risk Assessment

Reliable data regarding the usage patterns of personal care products (PCPs) are needed to determine the health risks posed by the ingredients of these products such as parabens, phthalates, and bisphenol A. There are no published data regarding the consumption patterns of PCPs in the Middle East in general and in Saudi Arabia in particular. To fill this gap, this study aimed to assess important factors such as the percentage of users and the frequency of use and co-use of twenty-three cosmetic and PCPs among the female population in Saudi Arabia. Additionally, this study aimed to assess the common cosmetic-related adverse events among the participants. The studied products included general hygiene, hair care, skin care, makeup, fragrances, and other products. The data were collected from 709 female participants of different age groups through a digital questionnaire. It was found that eighteen of the investigated products are consumed by at least 50% of the respondents. The frequency of use of PCPs varied over a wide range. Cosmetic-related adverse events were experienced by 16.1% of the participants. Use frequencies of many hygiene and makeup products were correlated with each other. This study provides, for the first time, baseline data on the usage patterns of a large number of widely consumed PCPs among female population pertaining to several sociodemographic strata. Such information is crucial for exposure and risk assessment and also needed for updating the current knowledge on usage of PCPs in Saudi Arabia.

The Microbe Directory: An annotated, searchable inventory of microbes' characteristics

The Microbe Directory is a collective research effort to profile and annotate more than 7,500 unique microbial species from the MetaPhlAn2 database that includes bacteria, archaea, viruses, fungi, and protozoa. By collecting and summarizing data on various microbes’ characteristics, the project comprises a database that can be used downstream of large-scale metagenomic taxonomic analyses, allowing one to interpret and explore their taxonomic classifications to have a deeper understanding of the microbial ecosystem they are studying. Such characteristics include, but are not limited to: optimal pH, optimal temperature, Gram stain, biofilm-formation, spore-formation, antimicrobial resistance, and COGEM class risk rating. The database has been manually curated by trained student-researchers from Weill Cornell Medicine and CUNY—Hunter College, and its analysis remains an ongoing effort with open-source capabilities so others can contribute. Available in SQL, JSON, and CSV (i.e. Excel) formats, the Microbe Directory can be queried for the aforementioned parameters by a microorganism’s taxonomy. In addition to the raw database, The Microbe Directory has an online counterpart ( https://microbe.directory/) that provides a user-friendly interface for storage, retrieval, and analysis into which other microbial database projects could be incorporated. The Microbe Directory was primarily designed to serve as a resource for researchers conducting metagenomic analyses, but its online web interface should also prove useful to any individual who wishes to learn more about any particular microbe.

Development and validation of a dispersive liquid-liquid microextraction method for the determination of phthalate esters in perfumes using gas chromatography-mass spectrometry

A simple, rapid, sensitive and eco-friendly method has been developed for the simultaneous determination, preconcentration and extraction of phthalate esters (dimethyl phthalate, diethyl phthalate, dibutyl phthalate, benzyl butyl phthalate and bis(2-ethylhexyl) phthalate) in perfumes using dispersive liquid-liquid microextraction (DLLME) coupled to gas chromatography-mass spectrometry (GC-MS). Various factors affecting the DLLME efficiency, including the type and volume of the extracting and dispersing solvents, salt addition and vortex extraction time were optimized. Under optimum conditions, the proposed method provided low detection limits (0.003-0.070 ng mL-1), high extraction recovery (85.6-95.8%), wide linearity range (1.0-1000 ng mL-1) with good regression coefficients (>0.9984) and good precision (RSD% < 4.2%). The optimized method was successfully utilized for the analysis of different branded perfume samples and satisfactory results were obtained.

Does the orientation of the distal radioulnar joint influence the force in the joint and the tension in the interosseous membrane?

OBJECTIVE

To investigate the effect of change in the orientation of the distal radioulnar joint on the force in the joint and the strain in the interosseous membrane.

DESIGN

Biomechanical study in fresh frozen cadavers.

BACKGROUND

The articular surfaces of the distal radioulnar joint may be orientated in parallel with the long axis of the forearm (a Type I joint) or at an oblique angle opening distally to the ulnar side (a Type II joint).

METHODS

Three cadaveric upper limbs were held on a custom built frame allowing measured rotation and axial loading across the wrist. Measurements of force in the distal radioulnar joint and strain in the interosseous membrane were taken and repeated after replacement of the distal radioulnar joint with prosthetic Type I and Type II joints.

FINDINGS

The force in the joint and the strain in the interosseous membrane increased with increasing load across the wrist (P < 0.0001). The force in the Type I joint was reduced compared to the normal or Type II joint. This difference was greater with increasing load and was significant at 8 kg (P < 0.001). The strain in the interosseous membrane was maximal at neutral forearm rotation and decreased with increasing pronation and supination.

INTERPRETATION

The force in the joint is greater with the Type II distal radioulnar joint. We believe this compressive force increases joint stability and this orientation of the articular surfaces should be considered in the design of a total distal radioulnar joint arthroplasty.

Simultaneous Determination of Drugs Affecting Central Nervous System (CNS) in Bulk and Pharmaceutical Formulations Using Multivariate Curve Resolution-Alternating Least Squares (MCR-ALS)

The quality of medications is important to maintain the overall health care of patients. This study aims to develop and validate a spectrophotometric method using multivariate curve resolution-alternating least squares (MCR-ALS) with correlation constraint for simultaneous resolution and quantification of selected drugs affecting the central nervous system (imipramine, carbamazepine, chlorpromazine, haloperidol, and phenytoin) in different pharmaceutical dosage forms. Figures of merit such as root-mean-square error of prediction, bias, standard error of prediction, and relative error of prediction for the developed method were calculated. High values of correlation coefficients ranged between 0.9993 and 0.9998 reflected high predictive ability of the developed method. The results are linear in the concentration range of 0.3-5 μg/mL for carbamazepine, 0.3-15 μg/mL for chlorpromazine, 0.5-10 μg/mL for haloperidol, 0.5-10 μg/mL for imipramine, and 3-20 μg/mL for phenytoin. The optimized method was successfully applied for the analysis of the studied drugs in their pharmaceutical products without any separation step. The optimized method was also compared with a reported HPLC method using Student's t test and F ratio at 95% confidence level, and the results showed no significant difference regarding accuracy and precision. The proposed chemometric method is fast, reliable, and cost-effective and can be used as an eco-friendly alternative to chromatographic techniques for the analysis of the studied drugs in commercial pharmaceutical products.

Necrotising fasciitis in an infant with congenital insensitivity to pain syndrome

We present a rare case of necrotising fasciitis in an infant with congenital insensitivity to pain syndrome. The aetiology, diagnosis and management of necrotising fasciitis in children are compared with those in adults. In contrast to adults, children affected by necrotising fasciitis are usually previously healthy and have no predisposing factors. Early diagnosis, intravenous antibiotics and aggressive surgical debridement are mandatory for an optimal outcome.

A biomechanical study of reattachment versus distal multistrand repair in distal division of the flexor digitorum profundus

Distal division of the flexor digitorum profundus (FDP) within 10mm of its insertion is commonly treated in the same manner as avulsion of the FDP, using the "button" technique or bone suture anchor fixation. Button and bone suture anchor fixation techniques have been associated with significant complications. Importantly, both lead to shortening of the FDP which may cause flexion contracture at the distal interphalangeal joint. This study compared the breaking strength of a multistrand distal suture with reattachment using the "button-on-the-nail" technique in a laboratory cadaver model of distal FDP division. The data showed that multistrand distal suture repair was at least as strong as reattachment and has the theoretical advantage of avoiding some of the acknowledged complications of reattachment techniques.

Immediate postpartum insertion of a sutured Lippes Loop

Use of the sutured Lippes Loop for immediate postpartum insertion was evaluated in 100 volunteers at the Kasr-el-Aini Hospital in Cairo. The intrauterine devices were inserted manually immediately after delivery of the placenta. There was an expulsion rate of 1.2 per 100 women at three months, one case of infection requiring treatment and one removal because of bleeding. One woman became pregnant and expelled the Loop. The two major problems associated with the use of an intrauterine device, high expulsion rate and perforation, were overcome by hand insertion of the Loop.