Pathovars, occurrence, and characterization of plasmid-mediated quinolone resistance in diarrheal Escherichia coli isolated from farmers and farmed chickens in Tunisia and Nigeria.

The poultry industry is a very important agricultural and industrial sector in Tunisia and Nigeria, with little information about occurrence of diarrheagenic Escherichia coli in the farmers and chickens. This study aimed to detect the prevalence of diarrheal E. coli in humans and poultry and to investigate plasmid-mediated quinolone resistance (PMQR) genes in both countries. Seventy-four isolates of E. coli were studied; nine different virulence genes were screened by PCR. Serotyping was performed only for pathotypes as well as the determining of antibiotic resistance profiles against 21 antibiotics. PMQR genes were investigated by PCR. EAEC was the most abundant pathotype (37/74; 50%) in human and chicken isolates, whereas single EHEC and EPEC (1/74, 1.35%) pathotypes were detected in Tunisia and Nigeria, respectively. About 17 (45.95%) quinolones/fluoroquinolones-resistant isolates were detected, from which the following PMQR genes were detected: aac(6')-Ib-cr (8/17, 47.05%), qepA (6/17, 35.29%), qnrA + qnrB (2/17, 11.76%), and qnrS gene (1/17, 5.88%). Our findings highlight high occurrence of EAEC pathotype in Tunisia and Nigeria, more frequent than EPEC and EHEC. Additionally, all E. coli pathotypes isolated from different sources (humans, poultry) showed resistance to several antibiotics, which are in use as therapeutic choices in Tunisia and Nigeria.

Cross-cultural comparison of mental illness stigma and help-seeking attitudes: a multinational population-based study from 16 Arab countries and 10,036 individuals.

BACKGROUND: There is evidence that culture deeply affects beliefs about mental illnesses' causes, treatment, and help-seeking. We aimed to explore and compare knowledge, attitudes toward mental illness and help-seeking, causal attributions, and help-seeking recommendations for mental illnesses across various Arab countries and investigate factors related to attitudes toward help-seeking. METHODS: We carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries among participants from the general public. RESULTS: More than one in four individuals exhibited stigmatizing attitudes towards mental illness (26.5%), had poor knowledge (31.7%), and hold negative attitudes toward help-seeking (28.0%). ANOVA tests revealed a significant difference between countries regarding attitudes (F = 194.8, p < .001), knowledge (F = 88.7, p < .001), and help-seeking attitudes (F = 32.4, p < .001). Three multivariate regression analysis models were performed for overall sample, as well as Palestinian and Sudanese samples that displayed the lowest and highest ATSPPH-SF scores, respectively. In the overall sample, being female, older, having higher knowledge and more positive attitudes toward mental illness, and endorsing biomedical and psychosocial causations were associated with more favorable help-seeking attitudes; whereas having a family psychiatric history and endorsing religious/supernatural causations were associated with more negative help-seeking attitudes. The same results have been found in the Palestinian sample, while only stigma dimensions helped predict help-seeking attitudes in Sudanese participants. CONCLUSION: Interventions aiming at improving help-seeking attitudes and behaviors and promoting early access to care need to be culturally tailored, and congruent with public beliefs about mental illnesses and their causations.

Management of neglected clubfoot in children using Ilizarov external fixator and minimal invasive surgery, Sub-Saharan Africa experience.

PURPOSE: To evaluate the outcomes of Ilizarov external fixator (IEF) and minimal invasive surgery (MIS) in correction of neglected club foot (NCF). METHODS: Thirty-seven feet in 24 child, between five and 15 years old were diagnosed as NCF. All were treated with Achilles tendon lengthening (ATL) and IEF for gradual correction. After IEF removal, cast was applied for six weeks to maintain correction of the deformity. RESULTS: There were 20 boys and four girls. Seven children had left (Lt), four children had right (Rt) while 13 children had bilateral foot deformity. The mean age at surgery was 10.3 (range 5-15) years with an average follow-up of 32.5 (range 24-96) months. All feet were graded as severe according to Pirani score. All feet were corrected after an average six weeks in IEF. After two years follow-up, 23 feet (16 patients) showed good results, five feet (3 patients) showed fair results and four feet (2 patients) had Rt side foot fair result while the Lt foot had good result in both patients. Five feet (3 patients) showed poor results. Eight patients had pin site infection. One case had infected skin and subcutaneous tissue and needed debridement. Two cases developed skin sloughing, changes in color and needed close follow-up. CONCLUSION: We recommend combined IEF and MIS as a suitable, efficient and successful salvage procedure in the management of severe idiopathic NCF in children especially in developing countries.

Thermo-alkali-stable lipase from a novel Aspergillus niger: statistical optimization, enzyme purification, immobilization and its application in biodiesel production.

The influences of nutritional components affecting lipase production from the new Aspergillus niger using wheat bran as substrate were studied by employing Plackett-Burman and central composite statistical designs. Out of the 11 medium components tested, sucrose, KH2PO4 and MgSO4 at final concentrations of 3.0, 1.0 and 0.5 g/L, respectively, were reported to contribute positively to enzyme production (20.09 ± 0.98 U/g ds). The enzyme was purified through ammonium sulfate precipitation followed by Sephadex G-100 gel filtration. Molecular mass of the purified lipase was 57 kDa as evident on SDS-PAGE. Different methods of immobilization were studied and the highest immobilization yield of 81.7 ± 2.18% was reported with agarose (2%) and the optimum temperature was raised from 45 to 50 °C. Immobilized lipase could retain 80% of its original activity at 60 °C after 1 hr of incubation, and was stable at pH values between neutral and alkaline pH. Lipase-catalyzed transesterification process of fungal oil resulted in a fatty acid methyl ester yield consisting of a high percentage of polyunsaturated fatty acids (83.6%), making it appropriate to be used as winter-grade biodiesel. The operational stability studies revealed that the immobilized lipase could keep 70% of its total activity after 5 cycles of the transesterification process.

Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia.

PURPOSE: The purpose of this study was to evaluate the outcome of Ilizarov external fixation (IE) versus dynamic compression plate (PO) in the management of extra-articular distal tibial fractures. METHODS: Between 2010 and 2011, extra-articular distal tibial fractures in 40 consecutive patients met the inclusion criteria. They were classified according to AO classification fracture type A (A1, A2, and A3). In a randomized method, two equal groups were managed using either IE or PO. PO was performed using open reduction and internal fixation (ORIF) and DCP through anterolateral approach. IE was done using Ilizarov frame. For the PO group, non-weight bearing ambulation was permitted on the second postoperative day but partial weight bearing was permitted according to the progression in union criteria clinically and radiologically. For the IE group, weight bearing started as tolerated from the first postoperative day. Physiotherapy and pin-site care was performed by the patient themselves. RESULTS: Modified Mazur ankle score was applied to IE (excellent 10, good 10) and in PO (excellent 2, good 8, poor 6). Data were statically analysed using (Mann-Whitney test). The rate of healing in the IE group (average 130) was higher than the PO (average 196.5); plus, there were no cases of delayed union or nonunion in the IE group (p value 0.003). CONCLUSION: It was found that IE compared with PO provides provision of immediate weight bearing as tolerated following postoperative recovery, irrespective of radiological or clinical healing with no infection, deformity or non-union.

Bioethanol Production from Characterized Pre-treated Sugarcane Trash and Jatropha Agrowastes.

Low production costs and a potential feedstock supply make lignocellulosic ethanol (bioethanol) an important source of advanced biofuels. The physical and chemical preparation of this kind of lignocellulosic feedstock led to a high ethanol yield. In order to increase the yield of fermentable sugars, pretreatment is an essential process step that alters the lignocellulosic structure and improves its accessibility for the expensive hydrolytic enzymes. In this context, the chemical composition of sugarcane trash (dry leaves, green leaves, and tops) and jatropha (shell and seed cake) was determined to be mainly cellulose, hemicellulose, and lignin. Hydrogen peroxide and sodium hydroxide were applied in an attempt to facilitate the solubilization of lignin and hemicelluloses in five agrowastes. The extraction of hydrogen peroxide was much better than that of sodium hydroxide. A comparative study was done using SEM, EDXA, and FTIR to evaluate the difference between the two methods. The pretreated wastes were subjected to saccharification by commercial cellulases (30 IU/g substrate). The obtained glucose was fortified with nutrients and fermented statically by Saccharomyces cerevisiae F-307 for bioethanol production. The results revealed the bioethanol yields were 325.4, 310.8, 282.9, 302.4 and 264.0 mg ethanol/g treated agrowastes from green leaves of sugarcane, jatropha deolied seed cake, tops sugarcane, dry leaves of sugarcane, and jatropha shell, respectively. This study emphasizes the value of lignocellulosic agricultural waste as a resource for the production of biofuels as well as the significance of the extraction process.

Correction of cubitus valgus and reconstruction of lateral humerus condylar defect using tricortical iliac graft in pediatric patients.

BACKGROUND: Neglected non-united lateral humeral condyle fractures in pediatrics are a probable cause of cubitus valgus deformity which is a disabling complication. The ideal management for this condition is still debatable. This study aimed to evaluate the reconstruction of a non-united lateral humerus condylar fracture complicated by cubitus valgus using a tricortical iliac crest graft in pediatric patients. PATIENTS AND METHODS: Twenty children suffering from cubitus valgus as a complication after a non-united fracture of the lateral humeral condyle were included in this study. They were managed by open reduction, screw fixation, and reconstruction by an autologous tricortical iliac bone graft. We compared the preoperative and postoperative range of motion of the elbow, alignment, and elbow function using the Mayo elbow performance index. RESULTS: There was a statistically significant improvement in the elbow range of motion postoperatively, and there was a highly significant improvement regarding the elbow alignment and function. CONCLUSION: Open reduction, screw fixation, and reconstruction by the autologous tricortical iliac bone graft is an effective technique for the management of cubitus valgus due to neglected non-united lateral humeral condyle fractures in pediatrics.

Antibiotic action and resistance: updated review of mechanisms, spread, influencing factors, and alternative approaches for combating resistance.

Antibiotics represent a frequently employed therapeutic modality for the management of bacterial infections across diverse domains, including human health, agriculture, livestock breeding, and fish farming. The efficacy of antibiotics relies on four distinct mechanisms of action, which are discussed in detail in this review, along with accompanying diagrammatic illustrations. Despite their effectiveness, antibiotic resistance has emerged as a significant challenge to treating bacterial infections. Bacteria have developed defense mechanisms against antibiotics, rendering them ineffective. This review delves into the specific mechanisms that bacteria have developed to resist antibiotics, with the help of diagrammatic illustrations. Antibiotic resistance can spread among bacteria through various routes, resulting in previously susceptible bacteria becoming antibiotic-resistant. Multiple factors contribute to the worsening crisis of antibiotic resistance, including human misuse of antibiotics. This review also emphasizes alternative solutions proposed to mitigate the exacerbation of antibiotic resistance.

A local Talaromyces atroroseus TRP-NRC isolate: isolation, genetic improvement, and biotechnological approach combined with LC/HRESI-MS characterization, skin safety, and wool fabric dyeing ability of the produced red pigment mixture.

BACKGROUND: During the last decade, enormous research efforts have been directed at identifying potent microorganisms as sustainable green cell factories for eco-friendly pigments. Talaromyces atroroseus has recently been shown to excrete large amounts of azaphilone mycotoxin-free red pigment mixture comprising some known coloring components together with many uncharacterized metabolites. In this study, a new Talaromyces atroroseus isolate was identified via sequencing of the fragment of the nuclear ribosomal gene cluster containing internal transcribed spacers and 5.8S rRNA gene. The parameters that affected the level of pigment production were optimized in uncommon static conditions of culture and genetic improvement, via γ-irradiation, to improve pigment yield. Moreover, chemical characterization using LC/MS and skin safety test of the target pigment mixture were precisely conducted to maximize its benefits as a natural and safe red pigment for wool fabrics. RESULTS: Molecular identification via the sequencing of the ITS of the rDNA encoding gene cluster revealed that the fungal isolate TRP-NRC was T. atroroseus TRP-NRC (deposited in GenBank under accession number MW282329). In the static conditions of culture, pigment production was dramatically enhanced to 27.36 g/L in an optimum yeast malt peptone medium of 2% mannitol at pH 2-4.5 and 30 °C for 7 days of incubation. Under exposure to a 400-Gy γ-radiation dose, pigment yield was increased to a 3-fold level higher than that recorded for the wild type. Based on the inter-simple sequence repeats (ISSR), as a molecular marker tool, the wild-type T. atroroseus TRP-NRC strain and its mutants were discriminated. The UHPLC/HRESI-MS analytical tool characterized 60 metabolites, including many unknown molecules, at appropriate concentrations. It is worthy to note that four mitorubrin derivatives were identified for the first time in T. atroroseus, i.e., mitorubrinolamine acetate, dihydro-PP-O, mitorobrinal, and mitorubrinol. The range of irritation indexes (0-0.1) demonstrated an adequate skin safety after the direct local application of the pigment mixture. Finally, the pigment mixture exhibited a remarkably good dyeing ability in wool fabrics, with high-fastness properties. CONCLUSIONS: Because of its sustainable and economic production, the target red pigment mixture may be applied in the future in textile, food, cosmetics, or different pharmaceutical industries after extensive conventional safety and toxicity studies, which are currently under consideration.

Arthrodiastasis of the hip.

BACKGROUND: Hip distraction in Legg-Calvé-Perthes disease unloads the joint, which negates the harmful effect of the stresses on the articular surface, which may promote the sound healing of the areas of necrosis. METHODS: Nonarticulated arthrodiastasis without soft tissue release using an Ilizarov external fixator was applied to 29 patients with Legg-Calvé-Perthes disease (older than 8 y at onset and lateral pillar type C or B). RESULTS: Follow-up period ranged from 2.5 to 11 years with an average of 7.5 years. Twenty-seven cases (93%) had improvement of the range of motion postoperatively. Preoperatively, all patients had constant pain, whereas at last follow-up 26 (86%) patients had no pain and 3 had an improvement. Stulberg classification was applied to 21 cases who reached skeletal maturity at last follow-up: 9 cases were type II, 7 cases were type III, 4 cases were type IV, and 1 case was type V. CONCLUSIONS: Nonarticulated hip distraction without soft tissue release seems to be a valid treatment option in cases with Legg-Calvé-Perthes disease where poor results are expected from conventional treatment.

A case report with review of literature of a rare variant of midfoot dislocations (mid-Chopart dislocation): Combined naviculo-cuneiform and calcaneo-cuboid dislocation.

Closed midfoot and Chopart dislocations are uncommon injuries. Moreover, a combination of these dislocations is extremely rare. A 30-year-old male presented to our emergency department with mid-Chopart dislocation (combined naviculo-cuneiform and calcaneo-cuboid dislocation). Adequate open reduction with dual approach (dorsomedial and dorsolateral) and fixation with K-wires were achieved. Although the patient had satisfactory functional outcome postoperatively, he developed midfoot arthritis 12 months later. This type of dislocation is not yet classified, with only few cases reported in the literature. LEVEL OF CLINICAL EVIDENCE: 4.

The Role of Dermal Regenerative Templates in Complex Lower Extremity Wounds.

Dermal regenerative templates (DRTs) provide an option for management of complex lower extremity wounds. DRTs may be used to achieve definitive wound closure by serving as a scaffold for local tissue infiltration. Healing with a DRT interface leads to histologic and structural properties similar to native skin. DRTs can be applied over deep wounds with exposed critical structures that may have required a local or free flap. DRTs are a valuable option for lower extremity limb reconstruction.

A comparative study on flavour components and therapeutic properties of unfermented and fermented defatted soybean meal extract.

Microbial fermentation of plant material alters the composition of volatile and non-volatile plant natural products. We investigated the antioxidant, anticancer, and antiviral properties of extracts of defatted soybean meal fermented with Aspergillus fumigatus F-993 or A. awamori FB-133 using in vitro methods. Gas chromatography-mass spectrometry analysis of soybean meal fermented with A. awamori FB-133 and A. fumigatus F-993 identified 26 compounds with 11,14-octadecadienoic acid and methyl ester (63.63%) and 31 compounds with butylated hydroxytoluene (66.83%) and δ-myrcene (11.43%) as main constituents, respectively. The antioxidant activities of DSM extract were 3.362 ± 0.05 and 2.11 ± 0.02 mmol TE/mL, FDSM treated with A. awamori FB-133 were 4.763 ± 0.05 and 3.795 ± 0.03 mmol TE/mL and FDSM treated with A. fumigatus F-993 were 4.331 ± 0.04 and 3.971 ± 0.02 mmol TE/mL as determined by ABTS and FRAP assays, respectively. Both fermented extracts had better antioxidant activity than the unfermented extract as shown by multiple antioxidant activity assays. The concentration of fermented extracts required for 50% inhibition of cell viability was significantly lower than that of the unfermented extract when tested against the human liver cancer cell line HepG2 as shown by cell viability assays, indicating strong anticancer activity. The IC50 values for DSM, FDSM with A. fumigatusF-993 and FDSM with A. awamori FB-133 were27, 16.88 and 8.60 µg/mL, respectively. The extract of FDSM with A. awamori FB-133 showed the strongest anticancer activity, compared to DSM and FDSM with A. FumigatusF-993 extracts. Fermented extracts also reduced hepatitis A virus titres to a greater extent than unfermented extracts, thus showing strong antiviral property. Hepatitis A virus titres were reduced by 2.66 and 3 log10/0.1 mL by FDSM with A. fumigatusF-993 and FDSM by A.awamori FB-133, respectively, compared to DSM (5.50 log10/0.1 mL). Thus, the fermentation of soybean meal with A. fumigatusF-993 or A. awamori FB-133 improves the therapeutic effect of soybean extracts, which can be used in traditional medicine.

Liposomal methotrexate hydrogel for treatment of localized psoriasis: preparation, characterization and laser targeting.

BACKGROUND: Because systemic treatment of psoriasis is associated with several adverse effects, methotrexate (MTX), either topically or as targeted delivery, has become a more-interesting alternative. MATERIAL/METHODS: Methotrexate liposomes (LMTX) were prepared from DPPC, soy PC, egg yolk PC, and cholesterol. We studied the characterization, formulation of hydrogel (MTX 0.25%), and skin permeability, and compared LMTX gel with plain MTX gel and placebo for treating localized psoriasis in a double-blind study using albino mice. Gel formulations were applied daily, followed by irradiation with 80 joules from a 650-nm diode laser 3 times weekly for 12 weeks. Changes in disease signs and histopathological features were assessed. RESULTS: Drug release increased as laser energy increased following Higuchi's diffusion model and changed to zero order with energies > or = 80 J; significantly more MTX was released at all time intervals. Both LMTX and FMTX gels showed zero order kinetic release and antipsoriatic activity. During 8 months' follow-up, up to 60% of the patients treated with LMTX gel had no recurrence; this difference was statistically significant. No clinically significant changes were seen regarding blood or other laboratory variables. CONCLUSIONS: Application of an 80-J diode laser to 0.25% LMTX hydrogel was beneficial for relieving psoriasis and did not exert systemic toxicity.

Managing flexion knee deformity using a circular frame.

UNLABELLED: Knee flexion deformity can cause marked physical disability. Acute correction, whether nonoperative or operative, may lead to serious complications. We treated 50 patients (71 knees) between 1994 and 2002 with the Ilizarov external fixator. The deformity was gradually corrected using Ilizarov principles. Of the 50 patients, 29 were affected unilaterally and 21 bilaterally. In 15 patients, there were associated deformities. In no patient did we surgically release soft tissues; in two patients with arthrodesed or congenitally fused knees, we performed osteotomy before distraction. All patients were assessed clinically and radiographically. We assessed knee flexion angle, range of motion, stability, presence of pain, and healing index. After a minimum followup of 1 year (mean 3.7 years; range, 1-8 years), 18 of 20 of the preoperatively nonambulatory patients having bilateral surgery could walk at last followup. Complications included pin tract infection in all patients, knee subluxation in three patients, and fracture related to treatment in seven patients. We believe gradual correction using a circular frame an effective method to treat flexion knee contractures. In patients with bilateral deformities, improvement in functional activity may be expected in most patients. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Oral methionine compared with intravenous n-acetyl cysteine for paracetamol overdose.

A short cut review was carried out to establish whether methionine was better than n-acetyl cysteine at reducing the severity of liver damage after paracetamol overdose. Thirty nine papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

The Taylor spatial frame for deformity correction in the lower limbs.

The Taylor spatial frame uses the slow correction principles of the Ilizarov system but adds a six-axis deformity analysis incorporated within a computer program. To evaluate its use in our community, we used it in lengthening and deformity correction of the lower limbs to treat 22 cases from 1999 to 2001. There were 14 females and eight males (average age 16.5 years). Our target was lengthening in eight cases, correction of deformities in eight and both in six. The results were excellent in 18 cases, good in two, and fair in two. Despite the cost, patient profile and a steep learning curve, our results were encouraging but less favorable than with the Ilizarov external fixator.