Detection of Antibiotic Resistance Genes (CTX-M, Van A and Van B) of Enterococcus faecalis Isolated from Children with Bacteremia by RT-PCR

Fever is one of the most common diseases affecting humans, as it results from any disease or development and worsening of the disease for most people with widespread infections in the body. Therefore, this study aimed to evaluate antibiotic resistance genes (CTX-M, Van A and Van B) of Enterococcus faecalis isolated from children with bacteremia by RT-PCR. A total of 200 children was enrolled in the study, 100 children with fever and 100 healthy children (not suffering from any problem); that is, they are a control group for the detection of antibiotic resistance genes (CTX-M, Van A and Van B) of Enterococcus faecalis by RT-PCR. The age of the two groups ranged from one to five years. Four ml of venous blood sample was collected from each child; the venipuncture area was sterilized first with alcohol at a rate of 70%, followed by medical iodine and then sterilized with alcohol again to avoid contamination with skin flora. The blood samples were cultured on media for isolating bacteria. Then, the resistant isolates of E. faecalis to Vancomycin and cefotaxime antibiotics were taken and kept in special nutrient agar media where the DNA of the bacteria was extracted using (Zymogene Extraction kit, Japan). The detection of the exact genes (CTX-M, Van A and Van B) was done using Real-Time PCR technology according to the protocol mentioned by the company (Sacace biotechnology, Italy). The study presented that 40% of children with fever have positive blood cultures compared with 5% in the control group, with a significant difference between the two groups (P<0.001). The study found that 32.5% of bacteremic children were due to S. aureus, 30%, 5%, and 4% were due to E. faecalis, E. coli, P. aeruginosa and Klebsiella spp, respectively, with significant difference (P<0.01). The study showed that 91.67% of E. faecalis isolates were sensitive to Levofloxacin, 83.33% to Amoxiclav, 66.67% to Erythromycin, 58.33% to Amikacin, 50% to Ampicillin, 33.33% to cefotaxime and Ceftriaxone and 25% toward Vancomycin. From 9 isolates resistant to Vancomycin, the study presented that 88.89% of them were observed with Van A gene production as detected by real-time PCR (P<0.001). The study also showed that 77.78% were observed with Van B gene production as detected by real-time PCR (P<0.001). The study revealed that all E. faecalis isolates resistant to cefotaxime and Ceftriaxone were characterized by CTX gene production as detected by real-time PCR (P<0.001).

Drivers and consequences of child marriage in a context of protracted displacement: a qualitative study among Syrian refugees in Egypt

Background

Child marriage is a human rights violation disproportionately impacting girls in low- and middle-income countries. In the Middle East region, conflict and displacement have prompted concerns that families are increasingly resorting to child marriage to cope with economic insecurity and fears from sexual violence. This study set out to examine child marriage among Syrian refugees residing in Egypt with the aim of understanding drivers of child marriage in this context of displacement as well as how child marriage affects refugee girls’ wellbeing.

Methods

This analysis draws from 15 focus group discussions (FGD) conducted with married and unmarried girls, as well as parents of adolescent girls in three governorates in Egypt. FGDs included a participatory ranking exercise and photo-elicitation. Additionally, we conducted 29 in-depth interviews with girls and mothers, as well as 28 key informant interviews with health providers, community leaders, and humanitarian actors. The data was thematically analyzed using a combination of inductive and deductive coding.

Results

A prevalent phenomenon in pre-war Syria, child marriage has been sustained after the influx of Syrian refugees into Egypt by pre-existing cultural traditions and gender norms that prioritize the role of girls as wives and mothers. However, displacement into Egypt engendered different responses. For some families, displacement-specific challenges such as disruptions to girls’ education, protection concerns, and livelihood insecurity were found to exacerbate girls’ vulnerability to child marriage. For others, however, displacement into urban areas in Egypt may have contributed to the erosion of social norms that favored child marriage, leading to marriage postponement. Among girls who were married early, we identified a range of negative health and social consequences, including lack of family planning use, disruption to schooling and curtailment of girls’ mobility as well as challenges with marriage and birth registration which accentuated their vulnerability.

Conclusion

Efforts to address child marriage among Syrian refugees must acknowledge the different ways in which displacement can influence child marriage attitudes and practices and should capitalize on positive changes that have the potential to catalyze social norm change. Moreover, targeted, focused and contextualized interventions should not only focus on preventing child marriage but also on mitigating its impacts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10718-8.

Health care providers' and mothers' perceptions about the medicalization of female genital mutilation or cutting in Egypt: a cross-sectional qualitative study

Background

Female genital mutilation/cutting (FGM/C) is a traditional harmful practice that has been prevalent in Egypt for many years. The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explored the drivers and motives behind why healthcare professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters.

Methods

The study drew on a “mystery client” approach, coupled with in-depth interviews (IDIs) and focus group discussions (FGDs) with health care providers (i.e. physicians and nurses) and mothers. It was conducted in three geographic areas in Egypt: Cairo, Assiut and Al Gharbeya.

Results

Study findings suggest that parents who seek medicalized cutting often do so to minimize health risks while conforming to social expectations. Thus, the factors that support FGM/C overlap with the factors that support medicalization. For many mothers and healthcare providers, adherence to community customs and traditions was the most important motive to practice FGM/C. Also, the social construction of girls’ well-being and bodily beauty makes FGM/C a perceived necessity which lays the ground for stigmatization against uncut girls. Finally, the language around FGM/C is being reframed by many healthcare providers as a cosmetic surgery. Such reframing may be one way for providers to overcome the law against FGM/C and market the operation to the clients.

Conclusion

These contradictions and contestations highlighted in this study among mothers and healthcare providers suggest that legal, moral and social norms that underpin FGM/C practice are not harmonized and would thus lead to a further rise in the medicalization of FGM/C. This also highlights the critical role that health providers can play in efforts to drive the abandonment of FGM/C in Egypt.

Electronic supplementary material

The online version of this article (10.1186/s12914-019-0202-x) contains supplementary material, which is available to authorized users.

Phenolic profiling of an extract from Eugenia jambos L. (Alston)--the structure of three flavonoid glycosides--antioxidant and cytotoxic activities

Phenolic metabolite profiling and identification using high performance liquid chromatography (HPLC) coupled to high resolution accurate mass spectrometry (HR-ESI-MS) with detection of negative ions was used for assaying the complex mixture of phenolics of an aqueous ethanol leaf extract of Eugeniajambos L. (Myrtaceae). Eight known polyphenolics were tentatively identified, and, in addition, three hitherto unknown flavonol-O-glycosides were detected in the extract. These unknowns were taken as the targets and isolated by means of consecutive polyamide S6, MCI gel and repeated Sephadex LH-20 column fractionation. The isolation and purification were monitored by HPLC/ESI-MS. The isolates were subsequently identified as quercetin 3-O-xylosyl-(1"' --> 2")-O-xyloside, myricetin 7-methylether 3-O-xylosyl-(1"' --> 2")-rhamnoside and myricetin 3',5'-dimethyl ether 3-O-xylosyl-(1"'-->* 2")-O-rhamnoside. All known metabolites were also separated by applying the same chromatographic techniques. ESI-MS, ¹H and ¹³C NMR spectra were then recorded, completely interpreted and confirmed by HR-ESI-MS and 2D NMR spectroscopy. In order to get information about biological activities of E. jambos the extract was tested for radical scavenging activity by DPPH and ORAC assay. In addition, its cytotoxicity was assessed by the neutral red assay against non-tumorigenic HaCaT keratinocytes and the human bladder carcinoma cell line 5637.

Phenolics from Caesalpinia ferrea Mart.: antioxidant, cytotoxic and hypolipidemic activity

Nine phenolics were isolated from the aqueous ethanol extract of the leaves of Caesalpinia ferrea. The isolates were characterized for the first time from that plant. The structures of all isolates (1-9) were elucidated by conventional methods, spectroscopic analysis, including 1 D and 2D NMR, and by HR-ESIMS as well. The antioxidant capacities using the ORAC method and the cytotoxic activity using the neutral red assay (NRU) for that extract and three major isolates have been evaluated. In addition, the hypolipidemic activity (in vitro and in vivo) of the extract has been assessed.

Soft tissue high grade myoepithelial carcinoma with round cell morphology: report of a newly described entity with EWSR1 gene rearrangement

The case of soft tissue malignant myoepithelioma is presented including clinicopathological, immunohistochemical and cytogenetic findings. A 36-year-old Saudi male patient suffered from large mass involving right scapula and right shoulder joint measuring 14x13x11 mm. Core biopsy revealed sheets and lobules of poorly differentiated small malignant cells with marked atypia and frequent mitosis. Initially, immunohistochemistry was reactive for vimentin, pan-cytokeratin, EMA and CD99. The case was negative for desmin, SMA, CD34, S-100 protein and GFAP. FISH analysis exhibited negativity for SS18 (18q11.2) gene rearrangement and positivity for EWSR1 (22q12) gene rearrangement and a diagnosis of Ewing/PNET was considered. Clinical behavior and therapeutic response did not match the diagnosis with re-evaluation. Wedge biopsy demonstrated aggregates of epithelioid cells besides calponin and P63 positivity. Final diagnosis of malignant myoepithelioma with EWSR1 gene rearrangement was issued; a new entity with aggressive course. Myoepithelial carcinoma of soft tissue exhibits a wide spectrum of cytomorphology with overlapping phenotype similar to other soft tissue sarcoma like synovial sarcoma, mesenchymal chondrosarcoma, epithelioid sarcoma as well as Ewing/PNET. Moreover, a new finding of EWSR1 gene rearrangement is recognized in malignant myoepithelioma with different fusion partners. Hence, myoepithelial carcinoma should be kept in mind in diagnosis of soft tissue tumors even with unusual phenotype and gene rearrangement.

Bone mineralization enhancing activity of a methoxyellagic acid glucoside from a Feijoa sellowiana leaf extract

The capability of an aqueous methanol extract obtained from the leaves of Feijoa sellowiana Berg. on possible prevention and treatment of osteoporosis has been examined by evaluating its stimulating effect on the two human osteoblastic cell lines HOS58 and SaOS-2. The extract was found to increase significantly the mineralization of cultivated human bone cell, whereby a clear increment (15.3 +/- 2.7%) in von Kossa positive area was determined when administering 25 microg/ml leaf extract. A phytochemical investigation of the extract has demonstrated the high phenolic content and led to the isolation and identification of twenty three of them, among which the new 3-methoxyellagic acid 4-O-beta-glucopyranoside was fully identified. All structures were elucidated on the basis of conventional analytical methods and confirmed by FTMS, 1D- and 2D-NMR data. The new compound was found to cause a significant increase of mineralized area at 20 microg/mL, while at lower concentrations the effect was not significant. However, an increase of the number of mineralized spots (nodules) at all tested concentrations of the compound was observed.

BDN programmes and the effect of medical students' interventions to promote child health in Sudan

Basic development needs (BDN) is an approach to community development that aims at improving quality of life through the full involvement and self-management of communities, supported by intersectoral collaboration. The objective of this study was to assess the effects of BDN implementation in an area of Sudan on aspects of a programme implemented by students from the Faculty of Medicine, University of Gezira. The study revealed that the joint implementation of BDN programmes and students' interventions brought about marked improvement of family and community practices as well as greater reduction in the incidence of all assessed major childhood illnesses (diarrhoea, cough and fever) than when the students' programme was implemented alone. BDN implementation also facilitated the retrieval of good quality community-based data.

Phenolics from extracts of Brahea armata with inhibitory effect against 5alpha-reductase type-II

Fractions of the aqueous alcohol extracts of the rind and kernel of Brahea aramata fruits have been investigated for their activity against 5alpha-reductase type II, which is expressed predominantly in the prostate. This isozyme represents a major target for drugs against benign prostate hyperplasia (BPH) and prostate cancer. Also, a structural analysis of the phytophenolics, present in both aqueous alcohol extracts as the major constituents, has led to the isolation of five phenolics, including the new natural product, 4',6'-dimethoxy beta,4,2'-trihydroxy chalcone from the rind extract and three phenolics, including the new natural product, 1-p-hydroxybenzoyl glycerol from the kernel extract. All structures were confirmed by ESI-MS and NMR analysis.

The economic impact of incorporating flexible endoscopy into a community general surgery practice

BACKGROUND

Flexible endoscopy is a vital component of gastrointestinal surgery. It has and will replace many of the surgical procedures now commonly performed. Flexible endoscopy, unfortunately, is not an integral part of surgical residency training based on resident operative experience as reported by the Residency Review Committee. Moreover, general surgeons have deferred the practice of flexible endoscopy to the gastroenterologists because of concerns over turf battles and referral patterns. The purpose of this study was to assess the overall case load and the economic impact of flexible endoscopy on the practice of general surgery in a community hospital setting.

METHODS

This retrospective review was performed over a 6-month period. The total cases and the total billings of inpatient and outpatient procedures for a group practice of five general surgeons in a community hospital were evaluated. The billings were the actual charges based on current procedural terminology (CPT) codes for these procedures using the Medicare fee schedule.

RESULTS

Of the 2,159 procedures performed, 1,154 involved flexible endoscopy cases accounting for 54% of all cases (1,154 of 2,159) performed from February 1, 2003 to July 31, 2003. Flexible endocopy accounted for 43% of the total charges. A. total of 46 surgical procedures and 216 future endoscopies were generated from the flexible endoscopic procedures. Future endoscopic cases were for surveillance of colonic neoplasia and Barrett's esophagus.

CONCLUSIONS

Flexible endoscopy contributed to a major portion of the caseload and revenue generated by the general surgery group studied. The overall impact of flexible endoscopy is even greater than reported because of the future endoscopic surveillance cases or surgical interventions generated on the basis of endoscopic findings.

Teucrol, a decarboxyrosmarinic acid and its 4'-O-triglycoside, teucroside from Teucrium pilosum

Teucrol, a decarboxy rosmarinic acid and its triglycoside, teucroside, 9'-decarboxyrosmarinic acid-4'-O-alpha-rhamnosyl-(1'''-->6''')-O-beta-galactosyl-(1'''-->4'')-O-alpha-rhamnoside, are two new natural phenolics which have been isolated and identified from the aqueous alcohol extract of the whole plant of Teucrium pilosum (Decne) Asch. & Schweinf. (Lamiaceae). Structures were determined by conventional methods of analysis and confirmed by MS and NMR spectral analysis, including 2D-homonuclear COSY experiment.

Unusual phenolic glycosides from Cotoneaster orbicularis

The whole plant of Cotoneaster orbicularis contains the novel di-C-glycosylflavone, 4",4"'-di-O-beta-glucopyranosyl-vicenin II, or 6,8-di-C-beta-Cellobiosylapigenin, as well as the hitherto unknown natural phenolic glucoside, gentisic acid 2-O-beta-glucopyranoside, or orbicularin. Further phenolics are protocatechuic, anisic, caffeic, p-coumaric acids, catechin, epicatechin, 2"-O-alpha-rhamnopyranosylvitexin, vitexin, rutin, isoquercetrin, hyperin and naringenin. All structures were determined by routine methods of analysis and confirmed mostly by 1H- and 13C-NMR.

Metabolic changes concerning the effect of castration on some blood constituents in male rabbits

This experiment was conducted to determine the effects of castration on some metabolic alterations concerning proteins, lipids and minerals metabolism in both immature and mature rabbits. Twenty male New Zealand White rabbits (10 immature and 10 mature) were used. Blood samples were collected from the immature and mature intact animals (control non castrated). Moreover, the castrated animal groups (immature and mature) were sampled at 2, 4, 6 and 8 weeks after castration. The obtained results revealed that, castration caused a significant decrease in serum total protein, albumin, alpha 1-globulins and alpha 2-globulins concentrations. Meanwhile, gamma-globulins level was decreased temporarily at 2 weeks after castration in mature rabbits. beta-globulins level revealed non significant decrease at 2 weeks after castration in immature rabbits followed by a non significant increase. In mature rabbits beta-globulins level non significantly increased. A significant decrease in serum total nucleic acid concentrations was observed after castration throughout the experimental periods, whereas the value of serum uric acid level markedly increased after castration. Serum lipids concentrations (total lipids, total cholesterol, phospholipids and non esterified fatty acids) were increased after castration. The value of serum trace elements including copper, iron, zinc and manganese concentrations showed a significant decrease after castration. The decrease in serum copper and zinc levels were markedly observed in mature castrated rabbits. Also, serum sodium and potassium concentrations were decreased after castration. Testosterone propionate administration in mature castrated rabbits restored most of the investigated serum blood parameters to the levels of intact non castrated mature rabbit. It could be concluded that castration (deficiency of testosterone) induced marked decrease in protein synthesis and increased protein degradation, but serum lipids markedly elevated after castration in both immature and mature animals. Also, castration caused a marked decrease in some serum minerals and trace elements.

Plasma concentrations of lipids and lipoproteins in newborn kids and female Baladi goats during late pregnancy and onset of lactation

Concentrations of blood lipids and some lipoproteins were investigated in normal female Baladi goats during late pregnancy, parturition and onset of lactation as well as in their newborn kids during the first two weeks of life. A total number of 60 herparinized blood samples was collected from does at 4, 3, 2 and 1 weeks pre-partum, day of parturition and at 1, 2, 3 and 4 weeks postpartum. In addition, blood samples were also collected from their newborn kids during the first two weeks of life (day of birth, 1 and 2 weeks of age). Plasma was separated and analyzed for concentration of total lipid, total cholesterol, triacylglycerols, phospholipids, non esterified fatty acids (NEFA) and some lipoproteins as high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C). The obtained results revealed that there was a significant decrease in plasma level of total lipids at one week after parturition. Plasma level of triaclyglycerols was significantly higher at 4, 3 and 2 weeks before parturition. This increase became very highly significant at one week before parturition. Meanwhile, plasma phospholipid concentrations showed a significant decrease at 3 weeks before parturition, followed by an significant increase at 2 and 3 weeks after parturition and highly significant increase at 4 weeks after parturition. The concentration of plasma NEFA showed a significant increase at 4 weeks before parturition followed by a very highly significant increase at 2 and 1 week before parturition. On the other hand plasma NEFA was non detected at 2, 3 and 4 weeks post-partum when compared with the value reported at day of parturition. Regarding plasma lipoprotein concentrations the obtained results showed that there was a significant increase in plasma HDL-C level at 2 and 3 weeks after parturition, followed by a very highly significant decrease at the fourth week post-partum. However, plasma LDL-C level showed a significant decrease at 3, 2 and 1 weeks before parturition, followed by a further highly significant decrease at 1 and 2 weeks post-partum. In newborn kids plasma concentrations of total lipids, total cholesterol, phospholipids, HDL-C and LDL-C were very markedly increased at 1 and 2 weeks of age. However, plasma triacylglycerol concentrations showed a highly significant decrease at 1 and 2 weeks of age. The concentration of plasma NEFA showed a very highly significant decrease at 2 weeks of age, whereas, at one week of age plasma NEFA were not detected in comparison with first day of life.

Use of 7,7,8,8-tetracyanoquinodimethane for spectrophotometric determination of certain local anaesthetics and procainamide hydrochloride

A simple and rapid spectrophotometric procedure has been developed for the determination of four local anaesthetics containing a free primary amine moiety and of procainamide hydrochloride as the drug substances and in dosage forms. The method is based on the reaction of the drug with 7,7,8,8-tetracyanoquinodimethane in alkaline solution to produce yellow products. The chromogen was measured at 473 nm. The effects of several variables on colour development were established. Job's plots of absorbance versus molar ratio of drug to reagent indicated a 1:1 ratio for all the drugs studied. Results of the analysis of drug substances and their dosage forms by the proposed method are in good agreement with those obtained by the USP XX method.

Spectrofluorometric assay of thiamine hydrochloride in injections and multivitamin preparations

A spectrofluorometric method is described for the determination of thiamine hydrochloride. The method is based on formation of a fluorescent product by oxidation of thiamine HCl with 2,3,5,6-tetrabromo-1,4-benzoquinone in aqueous acetonitrile solution. The reaction product is stable for at least 6 h and shows excitation and emission maxima around 355 and 420 nm, respectively. The method is highly selective for thiamine HCl in the presence of other B vitamins. Thiamine HCl can be determined at concentrations as low as 20-160 ng/mL of the final solutions. When the method was applied to the determination of thiamine HCl added to some commercially available multivitamin preparations, recoveries were 98.78-99.98%.

Simple and rapid spectrophotometric method for determination of adrenaline and isoprenaline

A simple, rapid, and specific method for determination of adrenaline bitartrate and isoprenaline sulfate was developed. The method is based on the oxidation reaction in aqueous solution of either adrenaline bitartrate or isoprenaline sulfate in the presence of silver oxide to give a red aminochrome measurable at 490 nm. The color is stable for 2 h. Beer's law is valid within a concentration range of 5-80 micrograms/mL for each drug. All variables were studied to optimize the reaction conditions. The method is specific for catecholamine drugs having a secondary amine in the side chain. Other catecholamines such as orciprenaline and noradrenaline do not interfere, and no interference was observed in the presence of common pharmaceutical adjuvants. Interference due to sodium metabisulfite and sodium chloride was circumvented. The validity of the method was tested by analyzing adrenaline injections and isoprenaline tablets. Good recoveries were obtained for these preparations. The results were comparable to those obtained by official procedures. The proposed method is also recommended as a stability indicating assay for oxidative degradation of both drugs.

Serological studies in the elderly

Sera from 108 elderly patients in psychiatric and general hospitals were tested for antibodies to seven viruses. Measles virus antibody levels were significantly higher in patients from the psychiatric hospital, regardless of diagnosis, than in those from other hospitals. Demented patients, regardless of their hospital, had significantly higher levels of antibody to adenovirus than control patients.