Novel silver nanoparticle-antibiotic combinations as promising antibacterial and anti-biofilm candidates against multiple-antibiotic resistant ESKAPE microorganisms

HYPOTHESIS

The emergence of Multiple Antibiotic Resistance (MAR) in ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pathogens is a global challenge to public health. The inherent antimicrobial nature of silver nanoparticles (AgNPs) makes them promising antimicrobial candidates against antibiotic-resistant pathogens. This study explores the combination of AgNPs with antibiotics (SACs) to create new antimicrobial agents effective against MAR ESKAPE microorganisms.

METHODS

AgNPs were synthesized using Streptococcus pneumoniae ATCC 49619 and characterized for structure and surface properties. The SACs were tested against ESKAPE microorganisms using growth kinetics and time-kill curve methods. The effect of SACs on bacterial biofilms and the disruption of cell membranes was determined. The in-vitro cytotoxicity effect of the AgNPs was also studied.

FINDINGS

The synthesized AgNPs (spherical, 7.37±4.55 nm diameter) were antimicrobial against MAR ESKAPE microorganisms. The SACs showed synergy with multiple conventional antibiotics, reducing their antibacterial concentrations up to 32-fold. Growth kinetics and time-kill studies confirmed the growth retardation effect and bactericidal activity of SACs. Mechanistic studies suggested that these biofilm-eradicating SACs probably resulted in the loss of bacterial cell membrane integrity, leading to leakage of the cytoplasmic content. The AgNPs were highly cytotoxic against skin melanoma cells but non-cytotoxic to normal Vero cells.

Protein interactions, molecular docking, antimicrobial and antifungal studies of terpyridine ligands

Resistance to antibiotics/antibacterials/antifungals in pathogenic microbes has been developing over the past few decades and has recently become a commonplace public-health peril. Thus, alternative nontoxic potent antibiotic agents are covertly needed to control antibiotic-resistant outbreaks. In an effort to combat the challenges posed by the co-occurrence of multidrug resistance, two terpyridine ligands 4'-(4-N,N'-dimethylaminophenyl)-2,2':6',2″-terpyridine (L1) and 4'-(4-tolyl)-2,2':6',2″-terpyridine (L2) have been designed, prepared and confirmed their structure by spectral studies. Thereafter, antimicrobial assay was performed against gram positive and negative bacterial strains along with fungal strains. Both compounds L1 and L2 exhibited remarkable inhibitory activities against bacteria, Escherichia coli and Staphylococcus aureus at MIC values 6.25 and 3.125 µg/ml, respectively. In addition, in silico molecular docking studies were ascertained with bacterial DNA gyrase and fungal demethylase. Furthermore, both L1 and L2 could bind Bovine Serum Albumin (BSA) protein and binding interaction has been studied with the help of UV-Visible and fluorescence spectroscopy. While fluorescence of BSA unperturbed in the presence of L2, an addition of L1 to the solution of BSA resulted significant quenching. The binding constant calculations at different temperature confirmed that the fluorescence quenching between BSA and L1 is predominantly static in nature. The toxicity of L1 and L2 was checked using Drosophila melanogaster. The toxicity analysis suggest both the dyes are non-cytotoxic in nature.Communicated by Ramaswamy H. Sarma.

Rapid Colorimetric and Fluorometric Discrimination of Maleic Acid vs. Fumaric Acid and Detection of Maleic Acid in Food Additives

An anthracene thiazole based Schiff base L was synthesized and employed for fluorescence switch-on detection of maleic acid in aqueous DMSO. The non-fluorescent L (10^-5 M) showed an instantaneous and selective fluorescence enhancement at 506 nm upon interaction with maleic acid (10^-5 M). Other potential carboxylic acids (10^-5 M), such as malic acid, citric acid, acetic acid, cinnamic acid, tartaric acid, succinic acid, fumaric acid, oxalic acid and malonic acid failed to alter the chromo-fluorogenic properties of L. Probe L can be employed to detect maleic acid down to 2.74 × 10^-6 M. The probe L showed good linearity from 2.97 to 6.87 µM. Analytical utility of L was examined by detecting maleic acid in various food additives and drosophila larvae.

Artists on Social Media: an Analysis of Personal Branding Strategies employed by Indian Independent Artists on Social Media Platforms

The main objective of this paper is to understand the different tactics and platforms used by independent artists successfully to promote themselves as a brand and garner attention to their music, building a fan base. The platforms include social media and other platforms and also understand the most favorable platform for promoting oneself as an artist. This paper also deals with the different strategies they use to promote themselves. The first part of the paper includes the evolution of the music industry, the rise of streaming services, and independent artists. The revenue models of famous streaming platforms and how much they earn through streaming. The second part deals with the definition of personal branding, the different subsections involved in branding, and the strategies in general used by independent music artists on different social media platforms. Organizations’ expenditure on online promotional activities is constantly and dynamically increasing in tandem with the increasing level of digital media consumption. Simultaneously, with increasing expenditures on digital promotion, it is clear that the effectiveness of activities carried out in the electronic space in its current form is decreasing. As a result, when promoting products and services has never been more difficult in the new market situation, organizations have begun to seek alternative methods of influencing consumers.

FEAMR: A Database for Surveillance of Food and Environment-Associated Antimicrobial Resistance

The rapid dissemination of antimicrobial resistance (AMR) has emerged as a serious health problem on an unprecedented global scale. AMR is predicted to kill more than 10 million people annually by 2050 leading to huge economic losses worldwide. Therefore, urgent action is required at the national as well as international levels to avert this looming crisis. Effective surveillance can play an important role in the containment of AMR spread by providing data to help determine AMR hotspots, predict an outbreak, maintain proper stewardship and propose immediate and future plans of action in this respect. Although many existing databases provide genetic and molecular information on AMR in microorganisms, there is no dedicated database of AMR from non-clinical samples. The FEAMR database is a one-of-its-kind database to provide manually collated and curated information on the prevalence of AMR in food and the environment. For designing the FEAMR webpage, Microsoft Visual Studio with HTML, CSS, ASP.NET, Bootstrap for the front-end and C# for the back-end were used. The FEAMR database is a free access resource (https://feamrudbt-amrlab.mu.ac.in/), accepting verified food- and environment-related AMR submissions from across the globe. To the best of our knowledge, it is probably the first database providing AMR-related surveillance data from non-clinical samples. It is designed from the ‘One Health Approach’ perspective to help in the containment of global AMR spread.

AB1416 WHAT IS THE FULL ECONOMIC COST OF DELAYED DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS IN THE UK?

Background

Axial Spondyloarthritis (AS) is an umbrella term for both inflammatory conditions known as Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis. AS generally develops in younger people. Symptoms typically start in the late teenage years to early twenties (with the average age of onset being 24). Hence this condition has a life-long impact, which could increase if left untreated. Average delay to diagnosis is over eight years after the appearance of symptoms. There are currently 220,000 people in the UK living with this painful and progressive form of inflammatory arthritis. While people wait for a diagnosis, many withdraw from socialising and find it harder to establish careers, form relationships, and start families. In addition to healthcare costs, that include multiple visits to GPs, prescription of unnecessary medication and extensive use of over the counter painkillers, there are intangible costs that have large impacts on patients and society. For example, quality of life for the patient, their earning and saving for retirement capacity, social care costs.

Objectives

To determine the full economic cost, including medical productively loss and other out of pocket related costs of delayed diagnosis for AS in the UK.

Methods

We are building an economic Markov model to determine a total cost per patient per year of delay. The model will project disease progression forward in time-steps with feedback loops to allow movement in states back and forth. Transition states within each time-step will be constructed according to the various stage of the disease and they will be used primarily to demonstrate an assessment of the costs in the time taken to a confirmed diagnosis. The model will capture symptoms and impacts of AS leading up to that diagnosis and before initiation of treatment. Assuming the one-year maximum ‘gold standard’ time to diagnosis that NASS would like to see to, the sum of costs prior to this in each consecutive cycle will be estimated.

The inputs will consist of the average delay to diagnosis per gender and age group, the health resources utilisation, the cost of managing the symptoms, cost related to productivity losses and any other parameters and costs reflecting real resources required to diagnose, confirm, treat, cope with, manage and accommodate AS symptoms. Data include anonymised diagnosed patient data with the pathways they followed pre-diagnosis shared under strict confidentiality data sharing agreement from the secondary health units participating in the project. Cost data gathered from national sources and research into AS, NHS unit costs reports, productivity related reports and interviews with people with AS and clinicians providing valuable insight into the condition. The model will be validated by experts in the field and sufferers of AS to ensure accurate representation of actual events.

Results

The results will be provided at the conference and this is work in progress. A preliminary analysis of anonymised data of the pathway of 513 people towards an AS diagnosis show that the delay on female patients is slightly longer (mean of 9.85 years) compared to male patients (mean of 9.39 years). In both genders the delay is higher if the patient present symptom after the age of 31 years increasing the mean of previous age groups by 5 to 9 yrs.

Table 1.FemaleMaleAge GroupObs.Mean95% CIObs.Mean95% CI0-1511-21.000.00, 13.7116-30493.592.69, 4.49144.004.013.45, 4.5731-455011.729.64, 13.80161.009.618.58, 10.6546-602418.1713.05, 23.2860.0015.9013.30, 18.5061+317.330.00, 52.5819.0028.5821.14, 36.02

Conclusion

The results will help the National Axial Spondyloarthritis Society (NASS) to build an economic case for earlier diagnosis. The interactive model will support decision making in the future by allowing assumptions to be changed e.g., changing prices over time; varying wage rates depending on staff and skill mix; and the anticipated scale of savings in actual practice.

References

[1]Standfield et al. (2014). Markov Modelling and DES in health care: a comparison. Journal of technology Assessment in Health C 30 (2) 166-172

Acknowledgements

With thanks to the National Axial Spondyloarthritis Society for commissioning this research and special thanks to Dale Webb and Jill Hamilton for their valuable support to contact clinician and sufferers of AS and for accessing necessary data. Importantly, thank you to the clinicians and sufferers of AS for their contribution to the research.

Disclosure of Interests

None declared

Borderline serous ovarian neoplasm: case report of a diagnostic challenge in intraoperative frozen sections

Surface epithelial tumors of the ovary account for 25% of all ovarian neoplasms. When composed predominantly of fibrous stroma, with glands and cysts forming a minor component, their appearance on imaging is often complex; cystic- to solid-appearing masses often raise suspicion of a malignant tumor. An accurate frozen histopathological diagnosis of a benign cystadenofibroma of this tumor can facilitate appropriate surgical management. However, it is equally important to diagnose areas of borderline changes/malignancy arising in these tumors, particularly when large or complex surface and inner papillary areas with multilayering or stratification are seen microscopically. We present here a case of bilateral complex ovarian mass in a 68-year-old woman, which was equivocal for malignancy on radiology, per operative gross examination as well as on frozen section evaluation. It was finally diagnosed as a borderline serous tumor (BOT) in a cystadenofibroma on histopathological examination.

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Borderline tumors among surface epithelial tumors with a prominent stromal component are uncommon.

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Adhesions & bilaterality with a prominent stromal component result in radiological interpretation of a complex ovarian mass.

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The Risk of Malignancy Index is usually <200 if the CA125 is low.

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Intraoperative surgical decisions are based on frozen section examination which are challenging.

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A benign tumor diagnosis may results in inadequate surgery, additional interventions later and possible tumor spread.

Waveguide design optimization for compact silicon photonic ferroelectric phase shifters

In this paper, a new, to the best of our knowledge, design for a ferroelectric BaTiO₃ cladded silicon photonic phase shifter with very small switching length for compact photonic integrated circuits (PICs) is proposed. The proposed design is based on the choice of a waveguide core with suitably slanted sidewalls in order to favor the desired polarization of ferroelectric cladding and to make guided modes spread toward the ferroelectric cladding with the consequence of further reduction in switching length compared to the conventional (rectangular core) structure. The proposed design also gives the additional benefit of having the identical switching length for both TE and TM modes with the same configuration. These results offer a viable strategy to realize compact non-volatile phase shifters for reconfigurable and programmable PICs.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Primary epiphyseal and metaepiphyseal tubercular osteomyelitis in children A series of 8 case

Clinical series of primary epiphyseal and metaepiphyseal tubercular osteomyelitis are few. The purpose of our study was to retrospectively review the presentation, healing response and functional results of 8 such cases in children.

MATERIAL AND METHODS

The patients were evaluated for pain, deformity, range of motion, limb length discrepancy (if any) and recurrence. Serial radiographs of the region were studied to see remineralization, obliteration of radiological lesions, status of physis and remodeling of the growth plate.

RESULTS

The mean patient age was 7.1 years. Average follow up was 3.7 years. The mean duration of symptom before presentation was 2.9 months (range, 0.5-8 months). Knee region was involved in 4, distal radius in 2, shoulder and distal fibula in 1 patient each. The lesions were either localized or diffuse depending upon physeal involvement and osseous destruction. At the last follow up, the involved joints were painfree and had useful range of motion. Limb length lengthening was seen in all knee patients. The diffuse variety resulted in premature physeal closure. The residual lucencies persisted for several years without any clinical manifestations.

CONCLUSIONS

Primary epiphyseal and metaepiphyseal tuberculosis was relatively uncommon. The clinical outcome was good following curettage and multidrug antitubercular therapy. The epiphyseal and metaphyseal lucencies persisted for several months even after successful treatment. The diffuse variety lead to premature physeal closure. Limb length lengthening was common sequelae of tuberculosis of knee region.

Sino-Nasal Status in Patients with Chronic Obstructive Pulmonary Disease

Background. Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with serious impact on quality of life (QoL). There are limited studies available supporting coexistence of sino-nasal involvement in COPD. Methods. A prospective study was conducted to evaluate sino-nasal status in patients with COPD (n=100) presenting to the Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur from July 2011 to October 2012. COPD was diagnosed based on the Global initiative on Obstructive Lung Disease (GOLD) guidelines. Sino-nasal status was assessed by detailed history, radiograph of the para-nasal sinuses (PNS), nasal endoscopy and mucociliary clearance time. Results. Sino-nasal symptoms were present in 74 patients with COPD; nasal discharge (75.7%) being the most common. Tobacco smokers with COPD had a higher occurrence of sino-nasal symptoms (76.8%). Radiograph of para-nasal sinuses showed that maxillary sinus was most commonly involved. Nasal endoscopy revealed discharge in 63.5% cases. Nasal mucociliary clearance time was delayed (>11 to >40 min) in 98% cases. Nasal mucociliary clearance time was significantly delayed (>20 min) in COPD patients who were tobacco smokers as compared to non-smokers (53.7% versus 16.7%) and also related with increasing severity of COPD. Conclusions. Our observations suggest that sino-nasal involvement and delayed mucociliary clearance are common in patients with COPD, especially in tobacco smokers. Assessment of upper airway involvement in all the patients with COPD can help better therapeutic intervention and improvement in QoL.

Nuclear carrier and RNA-binding proteins in frontotemporal lobar degeneration associated with fused in sarcoma (FUS) pathological changes

AIMS

We aimed to investigate the role of the nuclear carrier and binding proteins, transportin 1 (TRN1) and transportin 2 (TRN2), TATA-binding protein-associated factor 15 (TAF15) and Ewing's sarcoma protein (EWS) in inclusion body formation in cases of frontotemporal lobar degeneration (FTLD) associated with fused in sarcoma protein (FTLD-FUS).

METHODS

Eight cases of FTLD-FUS (five cases of atypical FTLD-U, two of neuronal intermediate filament inclusion body disease and one of basophilic inclusion body disease) were immunostained for FUS, TRN1, TRN2, TAF15 and EWS. Ten cases of FTLD associated with TDP-43 inclusions served as reference cases.

RESULTS

The inclusion bodies in FTLD-FUS contained TRN1 and TAF15 and, to a lesser extent, EWS, but not TRN2. The patterns of immunostaining for TRN1 and TAF15 were very similar to that of FUS. None of these proteins was associated with tau or TDP-43 aggregations in FTLD.

CONCLUSIONS

Data suggest that FUS, TRN1 and TAF15 may participate in a functional pathway in an interdependent way, and imply that the function of TDP-43 may not necessarily be in parallel with, or complementary to, that of FUS, despite each protein sharing many similar structural elements.

Risk Factors and Outcome of Neonates Born through Meconium Stained Amniotic Fluid in a Tertiary Hospital of Nepal

Introduction: The incidence of meconium aspiration syndrome is still high in the developing world contributing significantly to the neonatal mortality. The study was aimed to know the risk factors contributing to meconium aspiration syndrome and neonatal outcome in a tertiary government hospital of the country.Materials and Methods: It was a hospital based cross sectional study done over a period of three months. All live newborns born through meconium stained liquor were enrolled and all the details regarding mother, neonate were recorded. Odd’s ratio and bivariate analysis was done to assess the risk factors for meconium aspiration syndrome.Result: Out of all the deliveries 14.6% were meconium stained amniotic fluid and meconium aspiration syndrome developed in 6.6% of the neonates. Low Apgar score and premature rupture of membranes was significantly associated with the risk of occurrence of meconium aspiration syndrome. Neonates who developed meconium aspiration syndrome had mortality of 11.3%.Conclusion: Perinatal asphyxia and premature rupture of membranes were significantly associated with the development of meconium aspiration syndrome and neonates who developed meconium aspiration syndrome had high mortality.J Nepal Paediatr Soc 2015;35(1):44-48

Measurements of Elliptic and Triangular Flow in High-Multiplicity 3He+Au Collisions at √(s(NN))=200 GeV

We present the first measurement of elliptic (v(2)) and triangular (v(3)) flow in high-multiplicity (3)He+Au collisions at √(s(NN))=200  GeV. Two-particle correlations, where the particles have a large separation in pseudorapidity, are compared in (3)He+Au and in p+p collisions and indicate that collective effects dominate the second and third Fourier components for the correlations observed in the (3)He+Au system. The collective behavior is quantified in terms of elliptic v(2) and triangular v(3) anisotropy coefficients measured with respect to their corresponding event planes. The v(2) values are comparable to those previously measured in d+Au collisions at the same nucleon-nucleon center-of-mass energy. Comparisons with various theoretical predictions are made, including to models where the hot spots created by the impact of the three (3)He nucleons on the Au nucleus expand hydrodynamically to generate the triangular flow. The agreement of these models with data may indicate the formation of low-viscosity quark-gluon plasma even in these small collision systems.

Azimuthal-angle dependence of charged-pion-interferometry measurements with respect to second- and third-order event planes in Au+Au collisions at √[S(NN)]=200 GeV

Charged-pion-interferometry measurements were made with respect to the second- and third-order event plane for Au+Au collisions at sqrt[s_{NN}]=200  GeV. A strong azimuthal-angle dependence of the extracted Gaussian-source radii was observed with respect to both the second- and third-order event planes. The results for the second-order dependence indicate that the initial eccentricity is reduced during the medium evolution, which is consistent with previous results. In contrast, the results for the third-order dependence indicate that the initial triangular shape is significantly reduced and potentially reversed by the end of the medium evolution, and that the third-order oscillations are largely dominated by the dynamical effects from triangular flow.

Aspergilloma coexisting with idiopathic pulmonary fibrosis: a rare occurrence

Fungal ball (mycetoma/aspergilloma) is a saprophytic fungal infection that colonizes pre-existing lung cavities. Reported literature suggests its development in cystic lesions/cavitation associated with tuberculosis, sarcoidosis, bronchiectasis, lung abscess, and cavitating neoplasm to name a few. Coexistence of aspergilloma with idiopathic pulmonary fibrosis (IPF) has not been reported in literature so far, to the best of our knowledge. We hereby report the case of a 55-year-old female with IPF having fungal ball.

Hair: an unusual foreign body in airways presenting with haemoptysis in an adult patient

Haemoptysis is defined as expectoration of blood originating from the lungs or tracheo-bronchial tree. It is attributed to various causes like tuberculosis, bronchiectasis, lung cancer, mycetoma, foreign bodies etc. Various types of foreign bodies have been reported in the literature. We report the case of an adult female patient who presented with an episode of haemoptysis (150 mL) in whom flexible fibreoptic bronchoscopy revealed a single long hair at the carina going to left main bronchus. Following successful removal of this hair there were no further episodes of haemoptysis and the patient manifested clinical and radiological improvement.

Medium modification of jet fragmentation in Au+Au collisions at √[s(NN)]=200 GeV measured in direct photon-hadron correlations

The jet fragmentation function is measured with direct photon-hadron correlations in p+p and Au+Au collisions at √[s(NN)]=200 GeV. The p(T) of the photon is an excellent approximation to the initial p(T) of the jet and the ratio z(T)=p(T)(h)/p(T)(γ) is used as a proxy for the jet fragmentation function. A statistical subtraction is used to extract the direct photon-hadron yields in Au+Au collisions while a photon isolation cut is applied in p+p. I(AA), the ratio of hadron yield opposite the photon in Au+Au to that in p+p, indicates modification of the jet fragmentation function. Suppression, most likely due to energy loss in the medium, is seen at high z(T). The associated hadron yield at low z(T) is enhanced at large angles. Such a trend is expected from redistribution of the lost energy into increased production of low-momentum particles.

Observation of direct-photon collective flow in Au + Au collisions at √s(NN)] = 200 GeV

The second Fourier component v(2) of the azimuthal anisotropy with respect to the reaction plane is measured for direct photons at midrapidity and transverse momentum (p(T)) of 1-12 GeV/c in Au + Au collisions at √s(NN)] = 200 GeV. Previous measurements of this quantity for hadrons with p(T) < 6 GeV/c indicate that the medium behaves like a nearly perfect fluid, while for p(T) > 6 GeV/c a reduced anisotropy is interpreted in terms of a path-length dependence for parton energy loss. In this measurement with the PHENIX detector at the Relativistic Heavy Ion Collider we find that for p(T) > 4 GeV/c the anisotropy for direct photons is consistent with zero, which is as expected if the dominant source of direct photons is initial hard scattering. However, in the p(T) < 4 GeV/c region dominated by thermal photons, we find a substantial direct-photon v(2) comparable to that of hadrons, whereas model calculations for thermal photons in this kinematic region underpredict the observed v(2).