Antimicrobial Resistance Molecular Mechanisms of Helicobacter pylori in Jordanian Children: A Cross-Sectional Observational Study.

BACKGROUND: H. pylori antimicrobial resistance causes increasing treatment failure rates among H. pylori gastritis in children. This study investigates the molecular mechanisms of H. pylori antimicrobial resistance among Jordanian children. METHODS: Demographic, clinical, and laboratory data were recorded for children referred to Prince Hamzah Hospital. Clarithromycin, Metronidazole, and Levofloxacin susceptibility were tested via E-test. Clarithromycin-related mutations were investigated using Real-Time (RT)-PCR and Levofloxacin resistance was analyzed with DNA sequencing of the gyrA gene. RESULTS: 116 children were recruited, including 55.2% females and 55.2% in the age range of 10.1 to 14 years. A total of 82.7% were naïve to eradication therapy. H. pylori positivity was 93.9%, 89.6%, 61.7%, and 84.3% according to Rapid Urease Test, histology, culture, and RT-PCR, respectively. Resistance rates were 25.9% for Clarithromycin, 50% for Metronidazole, and 6.9% for Levofloxacin via E-test. A2142G or A2143G or a combination of both mutations concerning Clarithromycin resistance were documented in 26.1% of samples, while mutations in gyrA gen-related to Levofloxacin resistance were reported in 5.3% of samples. Antibiotic resistance was significantly affected by abdominal pain, anemia, hematemesis, and histological findings (p < 0.05). CONCLUSION: H. pylori resistance was documented for Metronidazole and Clarithromycin. RT-PCR for H. pylori identification and microbial resistance determination are valuable alternatives for cultures in determining antimicrobial susceptibility.

Eesophagogastroduodenoscopy in paediatrics: does abiding by the international guidelines lead to appropriate management? A cross-sectional study.

Objectives Esophagogastroduodenoscopy (EGD) is one of the most practiced procedures in paediatric gastroenterology. As with all other procedures, it is guided and controlled by specific guidelines developed and approved internationally. The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines are two of the most followed guidelines in paediatric gastroenterology. This study aimed to determine how optimal patient condition management is when following international paediatric gastroenterology guidelines and to correlate the appropriateness of EGD and other variables with positive or negative findings on EGD. DESIGN: A cross-sectional retrospective cohort of all first-time diagnostic upper endoscopies was conducted between 1 January 2016 and 1 February 2020, in Prince Hamzah Hospital in Jordan. PARTICIPANTS: Paediatric patients between 9 months and 14 years of age with indications for EGD. RESULTS: Overall, 529 diagnostic EGDs were performed during the study period. Helicobacter pylori-associated gastritis was the most common final diagnosis in 247 patients (47%). Furthermore, 488 (92%) EGDs were deemed appropriate, while 41 (7.7%) were considered inappropriate. Finally, 74.0% of all biopsies performed had positive contributive findings. CONCLUSIONS: Abiding by international guidelines in paediatric gastroenterology can optimise care for paediatric patients. General paediatricians are urged to follow guidelines rigorously when referring patients to minimise inappropriate procedures.

Experimental Validation and Evaluation of the Bending Properties of Additively Manufactured Metallic Cellular Scaffold Structures for Bone Tissue Engineering.

The availability of additive manufacturing enables the fabrication of cellular bone tissue engineering scaffolds with a wide range of structural and architectural possibilities. The purpose of bone tissue engineering scaffolds is to repair critical size bone defects due to extreme traumas, tumors, or infections. This research study presented the experimental validation and evaluation of the bending properties of optimized bone scaffolds with an elastic modulus that is equivalent to the young's modulus of the cortical bone. The specimens were manufactured using laser powder bed fusion technology. The morphological properties of the manufactured specimens were evaluated using both dry weighing and Archimedes techniques, and minor variations in the relative densities were observed in comparison with the computer-aided design files. The bending modulus of the cubic and diagonal scaffolds were experimentally investigated using a three-point bending test, and the results were found to agree with the numerical findings. A higher bending modulus was observed in the diagonal scaffold design. The diagonal scaffold was substantially tougher, with considerably higher energy absorption before fracture. The shear modulus of the diagonal scaffold was observed to be significantly higher than the cubic scaffold. Due to bending, the pores at the top side of the diagonal scaffold were heavily compressed compared to the cubic scaffold due to the extensive plastic deformation occurring in diagonal scaffolds and the rapid fracture of struts in the tension side of the cubic scaffold. The failure in struts in tension showed signs of ductility as necking was observed in fractured struts. Moreover, the fractured surface was observed to be rough and dull as opposed to being smooth and bright like in brittle fractures. Dimple fracture was observed using scanning electron microscopy as a result of microvoids emerging in places of high localized plastic deformation. Finally, a comparison of the mechanical properties of the studied BTE scaffolds with the cortical bone properties under longitudinal and transverse loading was investigated. In conclusion, we showed the capabilities of finite element analysis and additive manufacturing in designing and manufacturing promising scaffold designs that can replace bone segments in the human body.

Design and Validation of Additively Manufactured Metallic Cellular Scaffold Structures for Bone Tissue Engineering.

Bone-related defects that cannot heal without significant surgical intervention represent a significant challenge in the orthopedic field. The use of implants for these critical-sized bone defects is being explored to address the limitations of autograft and allograft options. Three-dimensional cellular structures, or bone scaffolds, provide mechanical support and promote bone tissue formation by acting as a template for bone growth. Stress shielding in bones is the reduction in bone density caused by the difference in stiffness between the scaffold and the surrounding bone tissue. This study aimed to reduce the stress shielding and introduce a cellular metal structure to replace defected bone by designing and producing a numerically optimized bone scaffold with an elastic modulus of 15 GPa, which matches the human's cortical bone modulus. Cubic cell and diagonal cell designs were explored. Strut and cell dimensions were numerically optimized to achieve the desired structural modulus. The resulting scaffold designs were produced from stainless steel using laser powder bed fusion (LPBF). Finite element analysis (FEA) models were validated through compression testing of the printed scaffold designs. The structural configuration of the scaffolds was characterized with scanning electron microscopy (SEM). Cellular struts were found to have minimal internal porosity and rough surfaces. Strut dimensions of the printed scaffolds were found to have variations with the optimized computer-aided design (CAD) models. The experimental results, as expected, were slightly less than FEA results due to structural relative density variations in the scaffolds. Failure of the structures was stretch-dominated for the cubic scaffold and bending-dominated for the diagonal scaffold. The torsional and bending stiffnesses were numerically evaluated and showed higher bending and torsional moduli for the diagonal scaffold. The study successfully contributed to minimizing stress shielding in bone tissue engineering. The study also produced an innovative metal cellular structure that can replace large bone segments anywhere in the human body.

Polymer Geogrids: A Review of Material, Design and Structure Relationships.

Geogrids are a class of geosynthetic materials made of polymer materials with widespread transportation, infrastructure, and structural applications. Geogrids are now routinely used in soil stabilization applications ranging from reinforcing walls to soil reinforcement below grade or embankments with increased potential for remote-sensing applications. Developments in manufacturing procedures have allowed new geogrid designs to be fabricated in various forms of uniaxial, biaxial, and triaxial configurations. The design flexibility allows deployments based on the load-carrying capacity desired, where biaxial geogrids may be incorporated when loads are applied in both the principal directions. On the other hand, uniaxial geogrids provide higher strength in one direction and are used for mechanically stabilized earth walls. More recently, triaxial geogrids that offer a more quasi-isotropic load capacity in multiple directions have been proposed for base course reinforcement. The variety of structures, polymers, and the geometry of the geogrid materials provide engineers and designers many options for new applications. Still, they also create complexity in terms of selection, characterization, and long-term durability. In this review, advances and current understanding of geogrid materials and their applications to date are presented. A critical analysis of the various geogrid systems, their physical and chemical characteristics are presented with an eye on how these properties impact the short- and long-term properties. The review investigates the approaches to mechanical behavior characterization and how computational methods have been more recently applied to advance our understanding of how these materials perform in the field. Finally, recent applications are presented for remote sensing sub-grade conditions and incorporation of geogrids in composite materials.