Identification of the endosymbionts from Sulla spinosissima growing in a lead mine tailings in Eastern Morocco as Mesorhizobium camelthorni sv. aridi.

AIMS: To identify the bacteria nodulating Sulla spinosissima growing profusely in a lead and zinc mine tailings in Eastern Morocco. METHODS AND RESULTS: In all, 32 rhizobial cultures, isolated from root nodules of S. spinosissima growing in soils of the mining site, were tolerant to different heavy metals. The ERIC-polymerase chain reaction (PCR) fingerprinting analysis clustered the isolates into seven different groups, and the analysis of the 16S rRNA sequences of four selected representative strains, showed they were related to different species of the genus Mesorhizobium. The atpD, glnII and recA housekeeping genes analysis confirmed the affiliation of the four representative strains to Mesorhizobium camelthorni CCNWXJ40-4T , with similarity percentages varying from 96·30 to 98·30%. The sequences of the nifH gene had 97·33-97·78% similarities with that of M. camelthorni CCNWXJ40-4T ; however, the nodC phylogeny of the four strains diverged from the type and other reference strains of M. camelthorni and formed a separated cluster. The four strains nodulate also Astragalus gombiformis and A. armatus but did not nodulate A. boeticus, Vachellia gummifera, Prosopis chilensis, Cicer arietinum, Lens culinaris, Medicago truncatula, Lupinus luteus or Phaseolus vulgaris. CONCLUSIONS: Based on similarities of the nodC symbiotic gene and differences in the host range, the strains isolated from S. spinosissima growing in soils of the Sidi Boubker mining site may form a different symbiovar within Mesorhizobium for which the name aridi is proposed. SIGNIFICANCE AND IMPACT OF THE STUDY: In this work, we show that strains of M. camelthorni species nodulating S. spinosissima in the arid area of Eastern Morocco constitute a distinct phylogenetic clade of nodulation genes; we named symbiovar aridi, which encompasses also mesorhizobia from other Mediterranean desert legumes.

Development of a new patient-reported outcome measure to assess activities and participation in people with systemic sclerosis: the Cochin 17-item Scleroderma Functional scale.

BACKGROUND: Patient-reported outcome measures (PROMs) aimed at assessing people with systemic sclerosis (SSc) have rarely involved the target population in the item- and domain-generation stage of the instrument construction. OBJECTIVES: To develop a new PROM assessing activities and participation in people with SSc. METHODS: A provisional International Classification of Functioning, Disability and Health (ICF)-based 65-item questionnaire previously developed from interviews of people with SSc was sent by email to all patients followed in the internal medicine department of Cochin hospital (n = 184) and enrolled in the Scleroderma Patient-centered Intervention Network Cohort. Items were reduced according to their metric properties. Dimensional structure of the questionnaire was assessed by principal component analysis, convergent and divergent validities by Spearman's rank correlation coefficient, internal consistency by Cronbach's α, and reliability by a test-retest method using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS: Overall, 113 of 184 patients (61·4%) completed the provisional questionnaire. The item-reduction process resulted in a 17-item questionnaire, the Cochin 17-item Scleroderma Functional scale (CSF-17). Principal component analysis extracted two dimensions: 10 items related to mobility (CSF-17 section A) and seven items related to general tasks (CSF-17 section B). We observed convergent validity of the CSF-17 total score with global activity limitation, pain, depression and aesthetic burden, and divergent validity with anxiety. Cronbach's α was 0·94 for section A and 0·95 for section B. ICC (n = 25 patients) was 0·92 for the CSF-17 total score. Bland-Altman analysis did not reveal a systematic trend for the test-retest. CONCLUSIONS: The CSF-17 is a new PROM assessing activities and participation specifically in people with SSc. Its content and construct validities are very high. What is already known about this topic? In the earliest stages of construction patient-reported outcomes (PROMs) for people with systemic sclerosis (SSc) rarely involve the target population. Instruments able to capture the specific needs of people with SSc in terms of activities and participation are lacking. What does this study add? The Cochin 17-item Scleroderma Functional Scale (CSF-17) is a new PROM assessing global activities and participation specifically in people with SSc. Patients' perspectives were prioritized at all stages of construction. What are the clinical implications of this work? The CSF-17 could be used in clinical practice and research to assess the efficacy of complex multidisciplinary interventions targeting activity limitations and participation restriction in people with SSc. Linked Comment: Clark and Denton. Br J Dermatol 2020; 183:610.

Robustness of a continuous direct compression line against disturbances in feeding.

The aim of the current study was to characterize the robustness of an integrated continuous direct compression (CDC) line against disturbances from feeding, i.e. impulses of API and short step disturbances. These disturbances mimicked typical variations that can be encountered during long-term manufacture. The study included a primary formulation, with API of standard particle size, which was manufactured at 5 and 10 kg/h production rates, and a modified formulation, with API of large particle size, which was manufactured at 5 kg/h production rate. Overall, the CDC line smoothened all the disturbances, fulfilling the USP uniformity of dosage units (UDU) limit for single tablets. However, runs with the modified formulation failed the pharmacopoeia UDU requirements for the entire run due to high variation between tablets. The primary formulation passed the requirements in all cases. The residence time distribution (RTD) results indicated that the primary formulation allowed better smoothening ability, and an increase in production rate led to poorer smoothening due to shorter RTD. The RTDs revealed that a substantial part of back-mixing took place after the blender. Thus, the tablet press has an important role in smoothening disturbances longer than the mean residence time of the blender, which was very short.

Mineral filters in sunscreen products--comparison of the efficacy of zinc oxide and titanium dioxide by in vitro method.

European legislation currently authorizes 26 sun filters among which, there is only one mineral filter: titanium dioxide. In the United States, two mineral filters are authorized: titanium dioxide in a maximum dose of 25% and zinc oxide. Zinc oxide is authorized in Europe, but its concentration level is not limited. A large number of commercial products are containing one of these mineral filters. The difference between these products lies in the percentage of the active substance, the way they are incorporated into the final product and the size of the primary particles. Depending on the ingredient used, there is a large variation in efficacy. The efficacy of the products tested was determined by an in vitro method using a spectrophotometer equipped with an integration sphere. Titanium dioxide was thus seen to be much more effective than zinc oxide; indeed no commercial form of zinc oxide tested can give a sun protection factor (SPF) higher than 10 at its maximum dose of use, unlike titanium dioxide which in its coated form (coated with alumina and with stearic acid, amongst others) gives a SPF of 38. This study has also allowed us to dispel the theory that talc--a raw material which has been used empirically for years in foundation in the belief that it has photoprotective effects--has an effect against sun rays. Talc proved to be particularly ineffective, as when it is used at a level of 25%, it only gives a totally negligible SPF of one unit.

Hyper immunoglobulin M immunodeficiency. (Dysgammaglobulinemia). Presence of immunoglobulin M-secreting plasmacytoid cells in peripheral blood and failure of immunoglobulin M-immunoglobulin G switch in B-cell differentiation.

The peripheral blood lymphocytes of nine patients with hyper immunoglobulin (Ig)M immunodeficiency were studied in an attempt to define the cellular basis of this disorder. B cells were normal in number but qualitatively abnormal in all patients. Approximately one-half of the B cell consisted of small lymphocytes (7-9 mum in diameter) bearing surface IgM and IgD, as well as C3 receptors. These cells were driven to secrete IgM but not IgG after in vitro stimulation by pokeweed mitogen. In the blood there were also large lymphocytes (10-14 mum in diameter) that possessed surface as well as intracytoplasmic IgM but lacked C3 receptors. These cells spontaneously secreted large amounts of IgM in vitro and on electron microscopy were found to be rich in rough endoplasmic reticulum. Such a subpopulation of lymphoid cells was not detected in normal peripheral blood and was unique for all patients with hyper IgM immunodeficiency studied.T cells from all patients were normal in number and in function both in vivo and in vitro and were able to generate adequate T-cell help to support IgG synthesis by normal B cells. No evidence was obtained for T cells capable of suppressing normal IgG synthesis in any of the patients after coculture with normal peripheral blood lymphocytes. The defect in hyper IgM immunodeficiency is intrinsic to B cells, which fail to switch from IgM to IgG synthesis.

Harnessing Wharton's jelly stem cell differentiation into bone-like nodule on calcium phosphate substrate without osteoinductive factors.

An important aim of bone regenerative medicine is to design biomaterials with controlled chemical and topographical features to guide stem cell fate towards osteoblasts without addition of specific osteogenic factors. Herein, we find that sprayed bioactive and biocompatible calcium phosphate substrates (CaP) with controlled topography induce, in a well-orchestrated manner, Wharton's jelly stem cells (WJ-SCs) differentiation into osteoblastic lineage without any osteogenic supplements. The resulting WJ-SCs commitment exhibits features of native bone, through the formation of three-dimensional bone-like nodule with osteocyte-like cells embedded into a mineralized type I collagen. To our knowledge, these results present the first observation of a whole differentiation process from stem cell to osteocytes-like on a synthetic material. This suggests a great potential of sprayed CaP and WJ-SCs in bone tissue engineering. These unique features may facilitate the transition from bench to bedside and the development of successful engineered bone. STATEMENT OF SIGNIFICANCE: Designing materials to direct stem cell fate has a relevant impact on stem cell biology and provides insights facilitating their clinical application in regenerative medicine. Inspired by natural bone compositions, a friendly automated spray-assisted system was used to build calcium phosphate substrate (CaP). Sprayed biomimetic solutions using mild conditions led to the formation of CaP with controlled physical properties, good bioactivity and biocompatibility. Herein, we show that via optimization of physical properties, CaP substrate induce osteogenic differentiation of Wharton's jelly stem cells (WJ-SCs) without adding osteogenic supplement factors. These results suggest a great potential of sprayed CaP and WJ-SCs in bone tissue engineering and may facilitate the transition from bench to beside and the development of clinically successful engineered bone.

Case Report Demonstrating the Safe and Effective Means of Expanding the Donor Pool With Livers Recovered From Brain-Dead Donors After Ethylene Glycol Toxicity.

The growing disparity between organ supply and demand has become the greatest hurdle facing transplant professionals and life-saving transplants. Because the organ shortage has become the rate-limiting step to effective transplants, it is critical for the transplant community to identify viable mechanisms to expand the donor pool and use every available allograft. Although using kidneys from deceased donors whose demise was secondary to ethylene glycol (EG) toxicity requires great deliberation and precise timing as described by Barbas et al [5], using hepatic allografts in this setting involves far less risk. The following is a discussion of a 61-year-old male who was diagnosed with end-stage liver disease secondary to non-alcoholic steatohepatitis and ultimately underwent a life-saving transplant with a liver recovered from a donor with EG-induced brain death and allocated nationally due to trepidation by local and regional centers to use the liver from a donor after EG toxicity.

Checklists to manage pain induced by exercise and mobilization (PIEM) during physical therapy programs: PIEM checklists for practitioners and physiotherapists.

OBJECTIVES: Identify key informational and educational items ("messages") to provide to physicians (general practitioners and specialists) and physiotherapists for the management of pain induced by exercise and mobilization (PIEM). Develop checklists to improve this management in daily practice. MATERIAL AND METHODS: The Delphi method for consensus-building was used to identify informational and educational messages for health professionals who deal with PIEM. Informed by the results of an extensive qualitative study, a panel of experts from 5 medical and paramedical disciplines concerned with PIEM and a representative of a patients' association were interviewed individually and iteratively in order to obtain a single, convergent opinion. RESULTS: Delphi consultation helped to determine 9 areas corresponding to 54 key messages of information and education for doctors and physiotherapists who deal with PIEM. These messages relate to: defining, characterizing, identifying, and evaluating PIEM; identifying factors that may cause or increase this pain; informing the patient in order to avoid misinterpretation of PIEM; preventing and treating PIEM; and dealing with it during physical therapy sessions. The method also enabled us to develop 2 synthetic instruments (checklists) - 1 for physicians and 1 for physiotherapists - to help with the management of this pain. CONCLUSION: Consulting a panel of experts comprising different categories of actors dealing with PIEM on the basis of a thorough qualitative diagnosis in order to identify messages for a training program makes it possible to harmonize programs with the expectations of patients and the problems encountered by professionals. The formulation of this program and the institutionalization of two checklists should enable health professionals to identify, qualify, and deal more effectively with PIEM.

[88 years of cutaneous leishmaniasis in Morocco]. / Quatre-vingt-huit années de leishmaniose cutanée au Maroc.

Leishmaniasis in its cutaneous form is a public health problem in Morocco. The objectives of this study were to assess the development of its epidemiological profile, identify the relevant species, and determine the location of the identified cases and their distribution by year, by sex, and by age. This retrospective epidemiological study covers a period of 88 years and concerns all reported cases of cutaneous leishmaniasis (CL) in Morocco from the first description in 1922 until 2010. During this period, 56,194 cases have been reported; they account for 95.7% of all cases of leishmaniasis (n = 58,710). The endemicity of CL has changed over time. The increase in its incidence is likely to be explained both by improved reporting and by a real increase in the number of cases.

Antimicrobial susceptibility patterns of bacterial isolates at the American University Medical Center in Lebanon.

In Lebanon, knowledge of the prevailing pattern of bacterial resistance to antimicrobial agents has been limited, particularly because of 15 years of civil strife. Thus, the current study was conducted to determine the antimicrobial susceptibility patterns of nonselected bacterial isolates recovered from recent clinical specimens, using the standardized disk agar diffusion technique. A total of 5216 isolates (1443 Gram positive and 3773 Gram negative) were examined. Over 92% of Staphylococcus aureus and coagulase-negative staphylococci (CNS) were resistant to penicillins. Methicillin resistance was more frequently noted among CNS (28%) compared with S. aureus (18%). For the pneumococci, 27% of the isolates were resistant to penicillin G. High but variable rates of multidrug resistance were encountered among Acinetobacter spp., Pseudomonas spp., Serratia spp., Citrobacter spp., and Enterobacter spp. Ampicillin resistance was detected in 65% of Escherichia coli and in 20% of Haemophilus influenzae isolates. Although one resistant Salmonella typhi strain was observed, 17% of other Salmonella spp. and 60% of Shigella spp. proved to be resistant to ampicillin, chloramphenicol, and cotrimoxazole. Among Vibrio cholerae isolates, high resistance to tetracycline (71%) and trimethoprim-sulfamethoxazole (94%) was observed. The overall antimicrobial resistance rates in Lebanon seem to fall between figures reported from the Arabian Gulf countries (higher) and those from medical centers in the United States (lower).

Interaction between a novel gemini surfactant and cyclodextrin: NMR and surface tension studies.

The interaction between cyclodextrins, hydroxypropyl-beta-cyclodextrin (HPbetaCD), and hydroxypropyl-gamma-cyclodextrin (HPgammaCD) and a novel type of nonionic surfactant synthesized from a fatty acid has been investigated. The so-called nonionic heterogemini surfactant (NIHG750) contains two hydrophobic groups and two hydrophilic groups, composed of one monomethyl ethylene glycol and one secondary OH group, CH(3)(CH(2))(7)-CH[OH]-CH[O(CH(2)CH(2)O)(16)CH(3)]-(CH(2))(7)CN. Surface tension studies indicate that micelles form in NIHG750 systems in both the presence and the absence of small quantities (molar ratio (HPbetaCD:NIHG750) approximately 2) of cyclodextrin (HPbetaCD or HPgammaCD). This gives NIHG surfactants an advantage compared to single-tailed nonionic surfactants, which generally lose their ability to micellize at much lower additions of cyclodextrins. However, the interaction between HPbetaCD and NIHG750 results in a disruption of the micellar aggregates at higher levels of cyclodextrin. In the dilute systems (C(NIHG750)<0.1% (w/w) approx) prolate-shaped mixed aggregates (HPbetaCD and NIHG750) form, with a short and a long axis of the order of 8-9 and 17-20 A, respectively. These gradually aggregate into micellar-like structures at higher concentrations. In the aqueous bulk phase HPbetaCD interacts mainly with the hydrophobic part of NIHG750, but both NMR and surface tension measurements indicate that an interaction with the hydrophilic part of NIHG750, as well, may exist. This interaction results in a better packing of NIHG750 at air-water interfaces. However, at elevated temperatures results from turbidity measurements indicate that NIHG750 and HPbetaCD interact mainly through the hydrophilic part of the surfactant; a decrease in the cloud point temperature is observed. The interaction of the larger cavity molecule, HPgammaCD, with NIHG750, on the other hand, seems to be relatively weak. The interaction, when present, most probably takes place through inclusion of the hydrophilic EO part of NIHG750. The results suggest that HPgammaCD in combination with NIHG750 is a better solubilizing system than with HPbetaCD.

Interactions between a nonionic gemini surfactant and cyclodextrins investigated by small-angle neutron scattering.

The microstructure of complexes between hydroxypropyl-cyclodextrins (HPCDs) (alpha, beta, and gamma) and a novel gemini surfactant has been investigated by small-angle neutron scattering (SANS). This nonionic hetero-gemini surfactant (denoted NIHG750) contains two hydrophobic groups and two hydrophilic groups. One is a methyl-capped polyoxyethylene chain with 16 oxyethylene units and the other is a secondary hydroxyl group. Various form factor models have been considered for fitting the SANS data. Spherical aggregates (25 to 40 A) with a size slightly larger than that of NIHG750 micelles (about 23 A) appear in mixed systems. These could be micellar aggregates partly covered with a few cyclodextrin molecules. In addition, the results indicate rod formation (r approximately 8 A, L approximately 70 A) for the NIHG-HPCD complexes. This result is consistent with the threading of HPCDs onto NIHG750 to such an extent that the surfactant molecule takes an extended conformation at high levels of HPCD. Also, the results indicate that HPCDs may interact with the oxyethylene groups of the spherical micellar aggregates leading to an increase in micelle size and a gradual transformation to rod-shaped aggregates. The tendency to form rods increases in the order gamma-CD

Serum immunoglobulin levels in normal children and adults in the Lebanese and other Arab Middle Eastern populations.

Serum immunoglobulin levels were determined in 1000 serum samples of normal middle easterners. Ig levels in mothers at delivery were normal except for a depressed IgG level. In cord blood the level of IgG was higher than its level in mothers, but no IgA or IgD was found. IgD was formed in some instances in the sera of infants in the first week of life. IgG showed a pattern similar to that described by others with the lowest values at 1-2 months, increasing gradually so that by 1-3 years the normal adult blood level is reached. IgA levels continued to increase with age and although no definite explanation is available, it is interesting to speculate on the possible relationship to the increased incidence of intestinal parasitism. IgM showed significant differences between males and females being higher in the latter. IgD levels reached maximum levels by 3-5 years, and mean levels ere lower after the 14th year.

Serum lipids and lipoprotein profile in a selected group of normal Lebanese subjects.

Serum triglycerides, total cholesterol, LDL, VLDL and HDL cholesterol levels were determined in a group of 442 apparently healthy Lebanese subjects after a 12 hr fast. Age-dependent increase was noted for total cholesterol, LDL cholesterol and triglycerides. On the other hand, VLDL and HDL cholesterol levels were age-independent. In addition, sex differences were noted for HDL cholesterol only. Our findings for total cholesterol and triglycerides are comparable with values reported by other authors, while values for LDL and VLDL are significantly different.

Hepatitis C virus : prevalence in Lebanese blood donors and brief overview of the disease.

Hepatitis C virus (HCV) is recognized as the major cause of non-A, non-B hepatitis. Its prevalence in different patient populations and blood donors has been reported worldwide but not yet from Lebanon. This study was performed to determine the prevalence of HCV antibodies in 536 random Lebanese blood donors using three enzyme immunoassay kits: ETI-AB-HCVK (Sorin, Biomedica, Italy), UBI HCV EIA (Organon Teknika, Netherlands) and ORTHO HCV 2.0 ELISA (Ortho Diagnostic Systems, USA). The latter was also used as an arbitrator test. Though ETI-AB-HCVK and UBI HCV EIA kits gave higher initial positive results (5.8% and 3.7%, respectively) than ORTHO HCV 2.0 ELISA (1.1%), the over all prevalence of HCV antibody in these blood donors was 0.7%. A brief review of the HCV virus, its epidemiology, clinical features and diagnostic aspects is also presented. A similar testing approach was carried out on additional 3643 blood donors. Confirmatory testing based on CHIRON*RIBA*HCV 2.0 strip immunoblot assay (Ortho) revealed that the HCV antibody seroprevalence in random Lebanese blood donors is 0.11% and not 0.7% as found by ELISAs alone.

Gonorrhea in the male: some aspects of treatment in Lebanon.

One hundred male patients with acute gonococcal urethritis were treated with various antibiotic and chemotherapeutic regimens. Pivampicillin, 1400 mg orally in two divided does at 5 hours' interval gave 100% cure in 60 patients. Gentamicin, 280 mg IM in one dose was equally efficaceous in 15 patients. Ampicillin and Trimethoprim-sulfamethoxazole gave cure rates of around 70%. While the results of the first two groups were in agreement with data published in different parts of the world, our results with the later two groups were contrary to those of other authors. The need for periodic evaluation of various antibiotic regimens in the treatment of gonorrhea is indicated.

Prevalence and etiology of intestinal parasites in Lebanon.

As there are no studies done on the prevalence of intestinal parasites in Lebanon since 1967, this study was undertaken to reveal the current patterns of intestinal parasitic infestations in Lebanese patients from two geographic regions: Beirut and Tripoli. Analysis was based on 33,253 stool specimens examined at the American University of Beirut Medical Center (AUH) and 11,611 specimens examined at the Islamic Hospital (IH) in Tripoli over five and three years, respectively. The prevalence of intestinal parasites at AUH and IH were 8.47% and 45.35%, respectively (overall 18%). The prevalence in males vs females was almost the same; being 8.23% vs 8.74%, and 44.67% vs 45.88%, at AUH and IH, respectively. Multiple infections were noted in 8.8% and 3.5% of stool specimens at AUH and IH, respectively. Although 18 different types of parasites were encountered, the most common pathogenic parasites found at AUH vs IH were: Giardia lamblia (20.7% vs 10.5% of parasites found), Entamoeba histolytica (19.41% vs 1.25%), Taenia spp. (6.03% vs 4.08%) and Ascaris lumbricoides (2.09% vs 46.97%). The overall yearly or monthly prevalence of parasites recovered from both hospitals did not show clear seasonal patterns. Compared to developed countries, Lebanon still suffers from a high prevalence and a wide spectrum of intestinal parasites.

Experience of the blood bank at the American University Hospital during the war in Lebanon.

The difficulties of switching from a community hospital blood bank type of practice to a field hospital blood bank operation with all the associated problems, are presented. Whole blood consumption markedly increased during the war while components use dropped and the voluntary benevolent donorship became the only source of blood supply. Guidelines of blood bank practice are derived from this experience.

Gene screening of Wharton's jelly derived stem cells.

Stem cells are the most powerful candidate for the treatment of various diseases. Suitable stem cell source should be harvested with minimal invasive procedure, found in great quantity, and transplanted with no risk of immune response and tumor formation. Fetal derived stem cells have been introduced as an excellent alternative to adult and embryonic stem cells use, but unfortunately, their degree of "stemness" and molecular characterization is still unclear. Several studies have been performed deciphering whether fetal stem cells meet the needs of regenerative medicine. We believe that a transcriptomic screening of Wharton's jelly stem cells will bring insights on cell population features.

Chitosan/hydroxyapatite hybrid scaffold for bone tissue engineering.

BACKGROUND: To favor regeneration following critical bone defect, a combination of autologous bone graft and biomaterials is currently used. Major drawbacks of such techniques remain the availability of the autologous material and the second surgical site, inducing pain and morbidity. OBJECTIVE: Our aim was to investigate the biocompatibility in vitro of three dimensions hybrid biodegradable scaffolds combining osteoconductive properties of hydroxyapatite and anti-inflammatory properties of chitosan. METHODS: Hybrid scaffolds were characterized by microscopic observations, equilibrium swelling ratio and overtime weight loss measurements. In vitro studies were performed using primary human bone cells cultured for 7, 14 and 21 days. Cell viability, proliferation, morphology and differentiation through alkaline phosphatase (ALP) activity measurement were assessed. RESULTS: Characterization of our scaffolds demonstrated porous, hydrophilic and biodegradable characteristics. In vitro studies showed that these scaffolds have induced slight decrease in cell death and proliferation comparing to the culture plastic substrate control condition, as well as increased short term osteoinductive properties. CONCLUSIONS: In this study, we have provided evidence that our hybrid hydroxyapatite/chitosan scaffolds could be suitable for bone filling.