Clinical risk scoring system for predicting extended-spectrum ß-lactamase-producing Escherichia coli infection in hospitalized patients.

BACKGROUND: Extended spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) has important implications for infection control and empiric antibiotic prescribing. This study aims to develop a risk scoring system for predicting ESBL-EC infection based on local epidemiology. METHODS: The study retrospectively collected eligible patients with a positive culture for E. coli during 2011 to 2014. The risk scoring system was developed using variables independently associated with ESBL-EC infection through logistic regression-based prediction. Area under the receiver-operator characteristic curve (AuROC) was determined to confirm the prediction power of the model. FINDINGS: Predictors for ESBL-EC infection were male gender [odds ratio (OR): 1.53], age ≥55 years (OR: 1.50), healthcare-associated infection (OR: 3.21), hospital-acquired infection (OR: 2.28), sepsis (OR: 1.79), prolonged hospitalization (OR: 1.88), history of ESBL infection within one year (OR: 7.88), prior use of broad-spectrum cephalosporins within three months (OR: 12.92), and prior use of other antibiotics within three months (OR: 2.14). Points scored ranged from 0 to 47, and were divided into three groups based on diagnostic performance parameters: low risk (score: 0-8; 44.57%), moderate risk (score: 9-11; 21.85%) and high risk (score: ≥12; 33.58%). The model displayed moderate power of prediction (AuROC: 0.773; 95% confidence interval: 0.742-0.805) and good calibration (Hosmer-Lemeshow χ(2) = 13.29; P = 0.065). CONCLUSION: This tool may optimize the prescribing of empirical antibiotic therapy, minimize time to identify patients, and prevent spreading of ESBL-EC. Prior to adoption into routine clinical practice, further validation study of the tool is needed.

Tandem measurements of iron and creatinine by cross injection analysis with application to urine from thalassemic patients.

This work presents development of a method for the dual determination of Fe(III) and creatinine using cross injection analysis (CIA). Two CIA platforms connected in series accommodated sample and reagents plugs aspirated via y-direction channels while water was pumped through the x-direction channel toward a flow-through cell of a diode array UV-vis. detector. Iron was detected from the colorimetric reaction between Fe(II) and 2-(5-bromo-2-pyridylazo)-5-(N-propyl-N-(3-sulfopropyl)amino) aniline (5-Br-PSAA), with prior reduction of Fe(III) to Fe(II) by ascorbic acid. The Jaffe's reaction was employed for the detection of creatinine. Under the optimal conditions, good linearity ranges were achieved for iron in the range 0.5 to 7 mg L(-1) and creatinine in the range 50 to 800 mg L(-1). The CIA system was applied to spot urine samples from thalassemic patients undergoing iron chelation therapy, and was successfully validated with ICP-OES and batchwise Jaffe's method. Normalization of urinary iron excretion with creatinine is useful for correcting the iron concentration between urine samples due to variation of the collected urine volume.

Bioequivalence study of a film-coated tablet of deferiprone in healthy Thai volunteers.

OBJECTIVE: To evaluate the bioequivalence of a single dose of deferiprone tablet manufactured locally (GPO-L-ONE, GPO, Thailand) with a reference formulation (Ferriprox, ApoPharma, Canada). VOLUNTEERS AND METHODS: A randomized, single dose, two-treatment, two-period, two- sequence crossover study was conducted in 24 healthy volunteers. Each subject received a single dose of 3 tablets of 500 mg deferiprone of both formulations with a two-week washout period. Blood samples were collected at 12 points for 480 min. Serum deferiprone levels were analyzed using high performance liquid chromatography (HPLC) method. Pharmacokinetic parameters were calculated from serum concentration-time curve and applying the non-compartment model. Statistical comparisons of Cmax, AUC(0-t), AUC(0-inf) values were evaluated after logarithmic transformation. Other pharmacokinetic parameters were tested non-parametrically. RESULTS: The C(max) value (mean +/- SD) for reference and test product was 32.4 +/- 13.2 and 27.8 +/- 12.8 microg/ml, respectively. Mean ratio (test/reference) of C(max) was 0.852 with 90% CI of 0.772 - 0.934. Mean ratio (test/reference) of AUC(0-t) was 0.962 with 90% CI of 0.914 to 1.012, and of AUC(0-inf) was 0.966 with 90% CI of 0.918-1.016. Both formulations were well tolerated and no adverse effects were observed. CONCLUSION: The 90% CI of mean ratio of AUC(0-t) and AUC(0-inf) fell within the acceptable range (0.80 - 1.25) for bioequivalent eligibility. Regarding the efficacy of deferiprone, which depends on AUC rather than C(max), 90% CI of mean ratio of C(max) was within the acceptable range of WHO criteria for bioequivalence study (0.75 - 1.33). Therefore the two film-coated formulations of deferiprone tablet were proven bioequivalent in healthy Thai volunteers.

Membraneless vaporization unit for direct analysis of solid sample.

A new apparatus, called 'membraneless vaporization' (MBL-VP) unit was designed and developed for direct analysis of solid samples. Solid analyte was converted into a gaseous form which then reacts with an indicator reagent. Change in absorbance was used to quantitate the analyte. Stirring with a magnetic bar was employed to facilitate the evaporation of the gas. Unlike the pervaporation technique, hydrophobic membrane was not required for this MBL-VP technique. Application of the membraneless technique for direct determination of calcium carbonate in calcium supplements, has shown to be very precise (R.S.D.=2.5% for 0.16 mmol CO3(2-)), with detection limit of 0.5 mg CaCO3. Results by this method agreed well with flame atomic absorption spectrometric method. Sample throughput was 20 samples h(-1).

Low cost telemetry with PC sound card for chemical analysis applications.

This work describes the development of a telemetric system in conjunction with a computer sound card for recording of signals. For signal transmission, a transmission wireless microphone was utilized, making the telemeter compatible with the sound card normally equipped inside a personal computer. The developed telemeter is a low-cost apparatus capable of remote monitoring. With the sampling rate of 10Hz, 100% accuracy was obtained up to a distance of 30m. The precision was good (%RSD=0.03-0.09), with relatively low noise. The effective signal range was from 0 to 2V, with approximately 1100 working steps (greater than 10bit A/D). The telemetric system was shown to be suitable for wireless recording of outputs from spectrophotometer and pH meter. Potential applications in chemical analysis were demonstrated.

Pervaporation-flow injection with chemiluminescence detection for determination of iodide in multivitamin tablets.

This paper describes the use of a pervaporation (PV) technique in a flow injection (FI) system for selective improvement in iodide analysis. Iodide in the sample zone is oxidized to iodine, which permeates through a hydrophobic membrane. Detection of the diffused iodine is achieved using the chemiluminescent (CL) emission at 425nm that results from the reaction between iodine and luminol. The method was applied for the analysis of some pharmaceutical products, such as nuclear emergency tablets and multivitamin tablets. Ascorbic acid present in multivitamin samples interfered seriously with the analysis, and off-line sample treatment using anion exchange resin was employed to successfully remove ascorbic acid before the analysis. Ascorbic acid was flushed from the column using 0.4M sodium nitrate followed by elution of iodide with 2M sodium nitrate. The detection limit (3S.D.) of the system was 0.5mgl(-1), with reproducibility of 5.2% R.S.D. at 5mgl(-1). Sample throughput was determined as 30injectionsh(-1). There was good agreement between iodide concentrations from extracted samples determined using four different methods, i.e., PV-FI, gas diffusion-flow injection, potentiometry and ICP-MS. A comparison of the analytical features of the developed pervaporation system with these of the previously reported chemiluminescence gas diffusion-flow injection previously reported is also described.

Cytoadherence between endothelial cells and P. falciparum infected and noninfected normal and thalassemic red blood cells.

BACKGROUND: Cytoadhesion of P. falciparum infected red blood cells (RBCs) to endothelial cells (ECs) is an important phenomenon that causes cerebral malaria in man. Reduced adhesion especially in thalassemia and hemoglobinopathies may be related to a protective mechanism against malaria in such people. METHODS: The cytoadherence assay was performed using both conventional and floating conditions between ECs (ECV 304) and P. falciparum infected and noninfected RBCs from both normal and thalassemia subjects. In floating condition, RBC was fluorescently labeled with anti-glycophorin A antibody, whereas EC was identified by surface expression of PECAM-1, CD-36, ICAM-1, and E-selectin. The condition of floating EC was similar to the condition for subcultivation as they can adhere or bind to any surface. The phosphatidylserine (PS) exposure was also determined by using flow cytometer. RESULTS: The adhesion of noninfected heterozygous thalassemic RBCs (all genotypes) to ECs was significantly increased as compared with normal RBCs (P < 0.02). Interestingly, after P. falciparum infection, the number of normal RBCs bound to ECs was significantly increased as compared with noninfected RBCs (P < 0.01), whereas heterozygous thalassemic RBCs infected by P. falciparum showed no significant difference compared with noninfected RBCs. In addition, we found a similar level of PS exposure in normal and thalassemic infected RBCs, which was related to the cytoadherence phenomenon. CONCLUSION: The reduced adhesion between heterozygous thalassemic RBCs infected by P. falciparum to ECs provides an explanation for their protective mechanism against malaria, as increased adhesion is a high risk for cerebral malaria and nonbinding infected RBCs can be removed by the reticuloendothelial system and other mechanism(s) in vivo.

A membraneless gas diffusion unit: design and its application to determination of ethanol in liquors by spectrophotometric flow injection.

This work presents new design of a gas diffusion unit, called 'membraneless gas diffusion (MGD) unit', which, unlike a conventional gas diffusion (GD) unit, allows selective detection of volatile compounds to be made without the need of a hydrophobic membrane. A flow injection method was developed employing the MGD unit to determine ethanol in alcoholic drinks based on the reduction of dichromate by ethanol vapor. Results clearly demonstrated that the MGD unit was suitable for determination of ethanol in beer, wine and distilled liquors. Detection limit (3S/N) of MGD unit was lower than the GD unit (GD: 0.68%, v/v; MGD: 0.27%, v/v). The MGD design makes the system more sensitive as mass transfer is more efficient than that of GD and thus, MGD can perfectly replace membrane-based designs.

A simple dual selection for functionally active mutants of Plasmodium falciparum dihydrofolate reductase with improved solubility.

Sufficient solubility of the active protein in aqueous solution is a prerequisite for crystallization and other structural studies of proteins. In this study, we have developed a simple and effective in vivo screening system to select for functionally active proteins with increased solubility by using Plasmodium falciparum dihydrofolate reductase (pfDHFR), a well-known malarial drug target, as a model. Prior to the dual selection process, pfDHFR was fused to green fluorescent protein (GFP), which served as a reporter for solubility. The fusion gene was used as a template for construction of mutated DNA libraries of pfDHFR. Two amino acids with large hydrophobic side chains (Y35 and F37) located on the surface of pfDHFR were selected for site-specific mutagenesis. Additionally, the entire pfDHFR gene was randomly mutated using error-prone PCR. During the first step of the dual selection, mutants with functionally active pfDHFR were selected from two libraries by using bacterial complementation assay. Fluorescence signals of active mutants were subsequently measured and five mutants with increased GFP signal, namely Y35Q + F37R, Y35L + F37T, Y35G + F37L and Y35L + F37R from the site-specific mutant library and K27E from the random mutant library, were recovered. The mutants were expressed, purified and characterized as monofunctional pfDHFR following excision of GFP. Our studies indicated that all mutant pfDHFRs exhibited kinetic properties similar to that of the wild-type protein. For comparison of protein solubility, the maximum concentrations of mutant enzymes prior to aggregation were determined. All mutants selected in this study exhibited 3- to 6-fold increases in protein solubility compared with the wild-type protein, which readily aggregated at 2 mg/ml. The dual selection system we have developed should be useful for engineering functionally active protein mutants with sufficient solubility for functional/structural studies and other applications.

Determination of iodide by detection of iodine using gas-diffusion flow injection and chemiluminescence.

This work describes development of a flow injection (FI) system for determination of iodide, based on the chemiluminescence (CL) reaction between iodine and luminol. Iodide in the sample zone is oxidized to iodine. Employment of a gas-diffusion (GD) unit allows for selective detection of the generated CL (425nm). Preliminary results showed for concentrations of less than 2mgL(-1), that signals were irreproducible and that the calibration was not linear. In order to solve these problems, a method of 'membrane conditioning' was investigated, in which iodide stream was continuously merged with oxidant to generate I(2) that conditioned the GD membrane and tubing. This minimized surface interaction between the active surface and the I(2) generated from the samples, thus improving both precision and sensitivity. By employing membrane conditioning, it has been possible to reliably detect concentrations down to 0.1mgL(-1). At the optimized condition, an excellent linear calibration (r(2) = 0.999) was obtained from 0.1 to 1.0mgL(-1). The method was successfully applied to determine iodide in some pharmaceutical products such as potassium iodide tablets and a liquid patent medicine. However, for vitamin tablets, ascorbic acid was found to interfere seriously by causing a negative signal.

Method development based on all injection analysis for the determination of phosphorus in soil and sediment extracts.

In this work, we have modified the technique of all injection analysis (AIA) by changing the position of the detector. The detection is then located as a part of the circulatory loop. With this new detector position, we could monitor for many numbers of circulation. The sensitivity was improved by using the cumulative signal data obtained when the number of circulation rounds was increased. The dilution effect using this new detector location was also less than that with the previous system. We employed a four-channel peristaltic pump to aspirate four types of liquids into the system together at one time. The AIA method was then developed for determination of phosphorus in soils and sediment extracts. The method was optimized for the new harmonized scheme of extraction that has been developed by the European Commission.

Flow-injection determination of iodide ion in nuclear emergency tablets, using boron-doped diamond thin film electrode.

The electrochemical determination of iodide was studied at boron-doped diamond thin film electrodes (BDD) using cyclic voltammetry (CV) and flow-injection (FI) analysis, with amperometric detection. Cyclic voltammetry of iodide was conducted in a phosphate buffer pH 5. Experiments were performed using glassy carbon (GC) electrode as a comparison. Well-defined oxidation waves of the quasi-reversible cyclic voltammograms were observed at both electrodes. Voltammetric signal-to-background ratios (S/B) were comparable. However, the GC electrode gives much greater in the background current as usual. The potential sweep rate dependence exhibited that the peak current of iodide oxidation at 1mM varied linearly (r(2) = 0.998) with the square root of the scan rate, from 0.01 to 0.30Vs(-1). This result indicates that the reaction is a diffusion-controlled process with negligible adsorption on BDD surface, at this iodide concentration. Results of the flow-injection analysis show a highly reproducible amperometric response. The linear working range was observed up to 200muM (r(2) = 0.999). The detection limit, as low as 0.01muM (3sigma of blank), was obtained. This method was successfully applied for quantification of iodide contents in nuclear emergency tablets.

Stage specificity of Plasmodium falciparum telomerase and its inhibition by berberine.

Telomerase activity in synchronized Plasmodium falciparum during its erythrocytic cycle was examined using the TRAP assay. Telomerase activity was detected at all stages of the parasite intraerythrocyte development, with higher activity in trophozoite and schizont stages compared with ring form. Berberine, extracted from Arcangelisia flava (L.) Merr., inhibited telomerase activity in a dose-dependent manner over a range of 30-300 microM, indicating that P. falciparum telomerase might be a potential target for future malaria chemotherapy.

Antimalarial alkoxylated and hydroxylated chalcones [corrected]: structure-activity relationship analysis.

Chalcones with 2',3',4'-trimethoxy, 2',4'-dimethoxy, 4'-methoxy, 4'-ethoxy, 2',4'-dihydroxy, and 4'-hydroxy groups on ring B were synthesized and evaluated in vitro against Plasmodium falciparum (K1) in a [3H] hypoxanthine uptake assay. The other ring A was quinoline, pyridine, naphthalene, or phenyl rings with electron-donating or electron-withdrawing substituents of varying lipophilicities. Trimethoxy 6 and 27, dimethoxy 7, 8, 29, and methoxy 31 analogues had good in vitro activities (IC(50) < 5 microM). 3-Quinolinyl ring A derivatives were well represented among the active compounds. Hydroxylated chalcones were less active than the corresponding alkoxylated analogues. When evaluated in vivo, 8 and 208 were comparable to chloroquine in extending the lifespan of infected mice. Multivariate data analysis showed that in vitro activity was mainly determined by the properties of ring B. Quantitative structure-activity relationship models with satisfactory predictive ability were obtained for various B ring chalcones using projections to latent structures. A model with good predictability was proposed for 19 active chalcones. Size and hydrophobicity were identified as critical parameters.

A novel two-protein component flavoprotein hydroxylase.

p-Hydroxyphenylacetate (HPA) hydroxylase (HPAH) was purified from Acinetobacter baumannii and shown to be a two-protein component enzyme. The small component (C1) is the reductase enzyme with a subunit molecular mass of 32 kDa. C1 alone catalyses HPA-stimulated NADH oxidation without hydroxylation of HPA. C1 is a flavoprotein with FMN as a native cofactor but can also bind to FAD. The large component (C2) is the hydroxylase component that hydroxylates HPA in the presence of C1. C2 is a tetrameric enzyme with a subunit molecular mass of 50 kDa and apparently contains no redox centre. FMN, FAD, or riboflavin could be used as coenzymes for hydroxylase activity with FMN showing the highest activity. Our data demonstrated that C2 alone was capable of utilizing reduced FMN to form the product 3,4-dihydroxyphenylacetate. Mixing reduced flavin with C2 also resulted in the formation of a flavin intermediate that resembled a C(4a)-substituted flavin species indicating that the reaction mechanism of the enzyme proceeded via C(4a)-substituted flavin intermediates. Based on the available evidence, we conclude that the reaction mechanism of HPAH from A. baumannii is similar to that of bacterial luciferase. The enzyme uses a luciferase-like mechanism and reduced flavin (FMNH2, FADH2, or reduced riboflavin) to catalyse the hydroxylation of aromatic compounds, which are usually catalysed by FAD-associated aromatic hydroxylases.

Determination of lidocaine in dental pulp by high-performance liquid chromatography.

The purpose of this study was to develop a method for lidocaine detection in dental pulp by high-performance liquid chromatography. The amounts of lidocaine in dog pulps were quantitated after local injection to evaluate lidocaine recovery from pulp tissue with this technique. Comparison was also made between the amount of lidocaine found in upper and lower canines. The high-performance liquid chromatography system was shown to be a reliable and reproducible tool for lidocaine determination. Lidocaine extraction from the tissue showed recovery of 90%. The amount of lidocaine recovered from the upper canine (0.21 microg/mg) was higher than the lower canine (0.17 microg/mg).

Inhibitory effects of 9-anilinoacridines on Plasmodium falciparum gametocytes.

Two gametocyte-producing isolates of Plasmodium falciparum, KT1 arid KT3, were cultivated in vitro. On day 11 of cultivation, pure gametocytes containing stage II, III and IV were used to test the gametocytocidal activity of 9-anilinoacridines that had previously demonstrated their activity against the asexual stage of the parasite. After drug exposure for 48 h, gametocytes were maintained without drugs for another 2 days before thin films were prepared for parasite counting. Gametocytocidal activities of 13 analogs of 9-anilinoacridine were observed with 50% inhibitory concentrations in the range of 0.6 microM to> 100 microM The most active compound was 1'-CH2NMe2-9-anilinoacridine. Anilinoacridine derivatives with 3,6-diamino substitution had reduced gametocytocidal activity in contrast to their enhancing effect against the asexual forms. Morphological abnormalities of gametocytes were observed following drug exposure.

Molecular defect of PKD1 gene resulting in abnormal RNA processing in a Thai family.

Autosomal dominant polycystic kidney disease (ADPKD) is a common human autosomal disorder caused mainly by mutations of the PKD1 gene. In analysis of PKD1 transcripts by long RT-PCR and nested PCR procedures, we observed PKD1-cDNA fragments from three ADPKD siblings from the same family with a size approximately 250 base pairs (bp) shorter than normal. Further investigations showed that the PKD1 transcripts from these patients had been abnormally processed, the nucleotide sequence of exon 43 containing 291 nt was missing from the transcripts, which would result in an abnormal polycystin-1 with an in-frame deletion of 97 amino acids. This splicing defect did not result from a mutation that disrupted the splice donor or acceptor sites adjacent to exon 43 or the branch sites in flanking introns but was most likely due to 20-bp deletion observed in intron 43. The intronic deletion was present in 8 affected members but absent in 11 unaffected members, corresponding with the results of genetic linkage analysis using 5 polymorphic markers in the PKD1 region. Molecular diagnosis of PKD1 in this family could, therefore, be carried out by genomic DNA amplification to directly detect the PKD1 intronic deletion.

Partial purification of mitochondrial DNA topoisomerase II from Plasmodium falciparum and its sensitivity to inhibitors.

Mitochondria of Plasmodium falciparum (K1 strain) were isolated by differential centrifugation. Mitochondrial DNA topoisomerase II from P. falciparum was partially purified using fast protein liquid chromatography(FPLC). Parasite mitochondria contained approximately 8% of DNA topoisomerase II activity compared with its nuclear fraction. The effects of fluoroquinolones, inhibitors of bacterial DNA topoisomerase II or DNA gyrase, against partially purified P. falciparum mitochondrial DNA topoisomerase II were investigated using a decatenation assay. Minimum inhibitory concentrations (MIC) of ofloxacin, ciprofloxacin and norfloxacin were > 1, 10 and 100 mM, compared with that of >0.5 and 10 mM for eukaryotic DNA topoisomerase II inhibitor etoposide (VP-16) and amsacrine, respectively. The results indicate that partially purified mitochondrial DNA topoisomerase II was insensitive to fluoroquinolones and it is suggested that their inhibitory effects on P. falciparum growth may be directed against plastid DNA topoisomerase II.

Partial purification and characterization of mitochondrial DNA polymerase from Plasmodium falciparum.

Mitochondria of chloroquine-resistant Plasmodium falciparum (K1 strain) were isolated from mature trophozoites by differential centrifugation. The mitochondrial marker enzyme cytochrome c reductase was employed to monitor the steps of mitochondria isolation. Partial purification of DNA polymerase from P. falciparum mitochondria was performed using fast protein liquid chromatography (FPLC). DNA polymerase of P. falciparum mitochondria was characterized as a gamma-like DNA polymerase based on its sensitivity to the inhibitors aphidicolin, N-ethylmaleimide and 9-beta-D-arabinofuranosyladenine-5'-triphosphate. In contrast, the enzyme was found to be strongly resistant to 2',3'-dideoxythymidine-5'-triphosphate (IC(50)>400 microM) and differed in this aspect from the human homologue, possibly indicating structural differences between human and P. falciparum DNA polymerase gamma. In addition, the DNA polymerase of parasite mitochondria was shown to be resistant (IC(50)>1 mM) to the nucleotide analogue (S)-1-[3-hydroxy-2-phosphonylmethoxypropyl]adenine diphosphate (HPMPApp).