Carbapenem-resistant Escherichia coli exhibit diverse spatiotemporal epidemiological characteristics across the globe.

Carbapenem-resistant Escherichia coli (CREC) poses a severe global public health risk. This study reveals the worldwide geographic spreading patterns and spatiotemporal distribution characteristics of resistance genes in 7918 CREC isolates belonging to 497 sequence types (ST) and originating from 75 countries. In the last decade, there has been a transition in the prevailing STs from highly virulent ST131 and ST38 to higher antibiotic-resistant ST410 and ST167. The rise of multi-drug resistant strains of CREC carrying plasmids with extended-spectrum beta-lactamase (ESBL) resistance genes could be attributed to three important instances of host-switching events. The spread of CREC was associated with the changing trends in blaNDM-5, blaKPC-2, and blaOXA-48, as well as the plasmids IncFI, IncFII, and IncI. There were intercontinental geographic transfers of major CREC strains. Various crucial transmission hubs and patterns have been identified for ST131 in the United Kingdom, Italy, the United States, and China, ST167 in India, France, Egypt, and the United States, and ST410 in Thailand, Israel, the United Kingdom, France, and the United States. This work is valuable in managing CREC infections and preventing CREC occurrence and transmission inside healthcare settings and among diverse hosts.

Microbiological Analysis and Content of Heavy Metals in Different Candies, Chocolates, and Their Wrappers in Bangladesh.

Present study investigates 39 brands of candies, chocolate, and litchis, purchased from Dhaka City, Bangladesh, for their moisture content, sulphated ash value, heavy metal, and bacterial contamination. All the brands showed moisture content (0.64%-4.775%) within the BSTI range, but sulphated ash values (18.80%-25.72%) were beyond the accepted value. Pb, Cd, Ni, and Cr ranged from 0.24-2.40 µg/g, 0.071-0.44 µg/g, 0.38-48.10 µg/g, and 0.50-12.79 µg/g, respectively, in the tested brands. Most of the brands contained Pb and Cd beyond the acceptable limits of WHO/FDA. Pb (2.24-2586.75 µg/g) was found in high concentration in the packaging of most brands, and Ni and Cd ranged from 2.10-108.05 µg/g and 1.68-45 µg/g, respectively. Bacterial presence was found in 15 brands, and 4 of them had a total aerobic bacterial count of >1 log CFU/g. Consumption of such contaminated confectionaries holds significant public health risks, specially in children, and demands necessary precautionary steps.

Immuno-physiological effects of dietary reishi mushroom powder as a source of beta-glucan on Rohu, Labeo rohita challenged with Aeromonas veronii.

Beta-glucans have immense potential to stimulate immune modulation in fish by being injected intramuscularly, supplemented with feed or immersion routes of administration. We studied how supplementing Labeo rohita's diet with reishi mushroom powder containing beta-glucan influenced immunological function. A supplemented diet containing 10% reishi mushroom powder was administered for 120 days. Afterwards, analyses were conducted on different immunological parameters such as antioxidants, respiratory burst, reactive oxygen species (ROS), alternative complement activity, and serum immunoglobulin, which resulted significant increases (p < 0.05; p < 0.01) for the reishi mushroom-fed immune primed L. rohita. Additionally, analyzing various hematological parameters such as erythrocytes and leukocytes count were assessed to elucidate the immunomodulatory effects, indicating positive effects of dietary reishi mushroom powder on overall fish health. Furthermore, the bacterial challenge-test with 1.92 × 104 CFU/ml intramuscular dose of Aeromonas veronii showed enhanced disease-defending system as total serum protein and lysozyme activity levels accelerated significantly (p < 0.01). Nevertheless, reishi mushroom powder contained with beta-glucan ameliorated the stress indicating parameters like acetylcholinesterase (AChE), serum-glutamic pyruvic transaminase (SGPT) and serum-glutamic oxaloacetic transaminase (SGOT) enzyme activities results suggested the fish's physiology was unaffected. Therefore, the results indicated that adding dietary reishi mushroom as a source of beta-glucan could significantly boost the immune responses in Rohu.

Prescription patterns in an intensive care unit of COVID-19 patients in Bangladesh: A cross-sectional study.

Background and Aims: To reduce death rates for critical patients hospitalized in intensive care units (ICUs), coronavirus (COVID-19) lacks proven and efficient treatment methods. This cross-sectional study aims to evaluate how physicians treat severe and suspected COVID-19 patients in the ICU department in the absence of an established approach, as well as assess the rational use of the medication in the ICU department. Methods: Between June 16, 2021, and December 10, 2022, a total of 428 prescriptions were randomly gathered, including both suspected (yellow zone) and confirmed (red zone) COVID-19 patients. For data management, Microsoft Excel 2021 was utilized, while STATA 17 provided statistical analysis. To find associations between patients' admission status and demographic details, exploratory and bivariate analyses were conducted. Results: Of the 428 patients admitted to the ICU, 228 (53.27%) were in the yellow zone and 200 (46.73%) were in the verified COVID-19 red zone. The majority of patients were male (54.44%), and the age range from 41 to 60 was the most common (41.82%). No significant deviation was detected to the yellow and red groups' prescription patterns. A total of 4001 medicines (mean 9.35/patient) were prescribed. Antiulcerants, antibiotics, respiratory, analgesics, anticoagulants, vitamins and minerals, steroids, cardiovascular, antidiabetic drugs, antivirals, antihistamines, muscle relaxants, and antifungal treatments were widely prescribed drugs. Enoxaparin (67.06%) appeared as the most prescribed medicine, followed by montelukast (60.51%), paracetamol (58.41%), and dexamethasone (51.64%). Conclusion: The prescription patterns for the yellow and red groups were comparable and mostly included symptomatic treatment. Respiratory drugs constituted the most frequent therapeutic class. Polypharmacy should be taken under considerations. In ICU settings, the outcomes emphasize the need of correct diagnosis, cautious antibiotic usage, suitable therapy, and attentive monitoring.

Virulence and antimicrobial resistance profile of non-typhoidal Salmonella enterica serovars recovered from poultry processing environments at wet markets in Dhaka, Bangladesh.

The rapid emergence of virulent and multidrug-resistant (MDR) non-typhoidal Salmonella (NTS) enterica serovars is a growing public health concern globally. The present study focused on the assessment of the pathogenicity and antimicrobial resistance (AMR) profiling of NTS enterica serovars isolated from the chicken processing environments at wet markets in Dhaka, Bangladesh. A total of 870 samples consisting of carcass dressing water (CDW), chopping board swabs (CBS), and knife swabs (KS) were collected from 29 wet markets. The prevalence of Salmonella was found to be 20% in CDW, 19.31% in CBS, and 17.58% in KS, respectively. Meanwhile, the MDR Salmonella was found to be 72.41%, 73.21%, and 68.62% in CDW, CBS, and KS, respectively. All isolates were screened by polymerase chain reaction (PCR) for eight virulence genes, namely invA, agfA, IpfA, hilA, sivH, sefA, sopE, and spvC. The S. Enteritidis and untyped Salmonella isolates harbored all virulence genes while S. Typhimurium isolates carried six virulence genes, except sefA and spvC. Phenotypic resistance revealed decreased susceptibility to ciprofloxacin, streptomycin, ampicillin, tetracycline, gentamicin, sulfamethoxazole-trimethoprim, amoxicillin-clavulanic acid, and azithromycin. Genotypic resistance showed a higher prevalence of plasmid-mediated blaTEM followed by tetA, sul1, sul2, sul3, and strA/B genes. The phenotypic and genotypic resistance profiles of the isolates showed a harmonic and symmetrical trend. According to the findings, MDR and virulent NTS enterica serovars predominate in wet market conditions and can easily enter the human food chain. The chi-square analysis showed significantly higher associations among the phenotypic resistance, genotypic resistance and virulence genes in CDW, CBS, and KS respectively (p < 0.05).

Complicated Spontaneous Coronary Artery Dissection (SCAD) Culminating in Aneurysm Formation: Coronary Artery Bypass Graft Surgery Is Preferable Over Percutaneous Coronary Intervention in Peripartum SCAD.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), most frequently occurring in young females of reproductive age, and has a high mortality rate. Currently, no guidelines are available to direct treatment. We report a case of a 29-year-old female with complications of SCAD treated with coronary artery bypass graft (CABG), resulting in a better outcome as compared to that of percutaneous coronary intervention (PCI). Our patient presented with class IV angina one-year post-PCI following postpartum SCAD. Left heart catheterization (LHC) reported SCAD involving the ostium of the left circumflex (LCX) and then cutting off the left marginal artery, which was followed by a 2.5 x 28 mm Synergy drug-eluting stent (Boston Scientific, Marlborough, MA) x1 in the lateral branch of the bifurcating marginal system with good coronary stent results. Repeat LHC one-year after the SCAD was significant for a large aneurysm in the distal left main coronary artery (LCA) extending into the LCX with evidence of a residual large false lumen (0.41 sq cm), as compared to the narrow segment of the true lumen (0.15 sq cm). Compared to the distal LCA area (0.49 sq cm), the true lumen of the LCA had severe stenosis. The patient underwent three-vessel CABG (left internal mammary artery (LIMA)-> left anterior descending artery (LAD), right internal mammary artery (RIMA)->first obtuse marginal (OM1), saphenous vein graft (SVG)->second obtuse marginal (OM2)) with sternal plating. The patient was doing well three months post-CABG with complete resolution of the pain, which was unattainable by PCI. Our report suggests that CABG may be preferable over PCI in the peripartum SCAD to avoid complications or sudden cardiac death from the extension of the dissection and aneurysm formation.

Spontaneous Coronary Artery Dissection: An Unusual Cause of ST-Elevation Myocardial Infarction in Young Males.

Spontaneous coronary artery dissection (SCAD) is a non-traumatic, non-iatrogenic, and non-atherosclerotic coronary artery disorder that manifests clinically as an acute coronary syndrome (ACS), arrhythmia, or sudden cardiac death (SCD). It is a rare cause of ACS (1.7-4%) and SCD (0.5%), more commonly in women than men. It is rarely reported in males. We report a case of acute ST-elevation myocardial infarction (STEMI) due to SCAD in a 44-year-old healthy male.

Pill to Pain: First Case of Topiramate-Induced Chronic Spontaneous Coronary Artery Dissection (SCAD).

Spontaneous coronary artery dissection (SCAD) is a non-traumatic, non-iatrogenic, and non-atherosclerotic coronary artery disorder that manifests clinically as acute coronary syndrome (ACS), arrhythmia, or sudden cardiac death (SCD). It is a rare cause of ACS (1.7%-4%) and SCD (0.5%), more common in women than men. It was first reported in 1931 in a 42-year-old female at autopsy, who had SCAD after violent retching and vomiting. We report a case of a 51-year-old female who developed sudden-onset chest pain after taking topiramate (TPM). Her chest pain persisted for 1.5 months prior to her outpatient evaluation, which led to further cardiac workup. An urgent left heart catheterization (LHC) revealed a SCAD. Her symptoms improved with percutaneous coronary intervention (PCI), and she was discharged home on aspirin, statins, and beta-blockers.

Cardiac amyloidosis: diagnostic challenges and recent advancement in the treatment of transthyretin amyloidosis (ATTR).

ATTR-CA is an under-reported cause of congestive heart failure (CHF) and cardiac arrhythmias. Heightened clinical suspicion along with a multimodal investigative approach is often required in diagnosing this potentially fatal condition. Tafamidis and inotersen have shown promising results in terms of progression-free survival by ameliorating CHF symptoms and peripheral neuropathies in clinical trials. In this case series of five patients, we present three wild-type cardiac amyloidosis (ATTRwt-CA), one familial cardiac amyloidosis (ATTRm-CA) and one primary cardiac (AL-CA). The diagnostic modality was different for each patient. ATTRwt-CA, ATTRm-CA and AL-CA patients received tafamidis, inotersen and chemotherapy with bone marrow stem-cell transplantation, respectively.

Assessing the impacts of in-feed probiotic on the growth performance and health condition of pangasius (Pangasianodon hypophthalmus) in a farm trial.

The effects of in-feed probiotics on growth performance, haematological parameters, gut microbial content, and morphological changes to pangasius fish were assessed. The trial had three phases, i.e., larvae to fry (20 days), fry to fingerlings (45 days), and grow-out phase from fingerlings to marketing (90 days). The stocking densities were 400 m-3, 200 m-3, and 12 m-3 for phases 1, 2, and 3, respectively. Phases 1 and 2 were conducted in hapas in the same pond, whereas phase 3 was performed in concrete tanks. The in-feed probiotic was administered at a rate of 0.2 g kg-1 of feed three times per day in phases 1 and 2 only. In phase 3, in-feed probiotics was not applied to any groups. The treated group exhibited higher growth performances (p < 0.05) than the control in all three phases of experiment. The survival % in phase 1 and 2 were found significantly (p < 0.05) higher in treatment groups. This indicates that pangasius nurserers would benefit from using probiotics as a safeguard to increase fry survival to a greater extent. Two haematological parameters including red blood cells (RBC) and white blood cells (WBC) levels were found significantly (p < 0.05) higher in treated groups in phase 2 and 3, while glucose and hemoglobin level were found significantly (p < 0.05) higher in the treated groups during phases 2 and 3, respectively. The gut microbiota content was relatively higher in the treated groups in phase 2 and 3. Histological findings indicate that the use of probiotics during the nursing phases of pangasius induced a positive change in the intestinal morphological structures. The positive impacts of probiotics on the phase 3 confirmed an immediate and long-term growth performance and health of pangasius.

STEMI associated with SARS-CoV-2 infection and the use of ECMO as a potential therapeutic approach in addition to the PCI.

A 55-year-old male presented to the emergency department with the complaints of chest pain that started 4 h before presentation. Pain was located over the anterior chest, 5 out of 10 intensity, with radiation to the left arm. Chest x-ray on admission showed severe diffuse bilateral pulmonary infiltrates concerning for COVID-19 pneumonia. Electrocardiogram showed inferior and lateral ST-segment elevation compatible with acute inferolateral myocardial infarction. Successful percutaneous coronary intervention (PCI) of the proximal and mid-right coronary artery using the balloon angioplasty and drug-eluting stent was performed. Post-PCI stenosis was 0% with a thrombolysis in myocardial infarction (TIMI) flow of 3. Five-day course of azithromycin and hydroxychloroquine was completed with no improvement overall. Patient received two doses of 400 mg of tocilizumab intravenously on hospital days 5 (HD#5) and #6. The patient was proned, on FiO2 100%, PEEP 15 cm H2O, on epoprostenol sodium and paralytics and eventually received venovenous ECMO, which improved outcome.

Molecular Detection of Multidrug Resistant Salmonella Species Isolated from Broiler Farm in Bangladesh.

Multidrug resistant (MDR) Salmonella are a leading cause of foodborne diseases and serious human health concerns worldwide. In this study we detected MDR Salmonella in broiler chicken along with the resistance genes and class 1 integron gene intl1. A total of 100 samples were collected from broiler farms comprising 50 cloacal swabs, 35 litter and 15 feed samples. Overall prevalence of Salmonella was 35% with the highest detected in cloacal swabs. Among the Salmonella, 30 isolates were confirmed as S. enterica serovar Typhimurium using molecular methods of PCR. Disk diffusion susceptibility test revealed that all the Salmonella were classified as MDR with the highest resistance to tetracycline (97.14%), chloramphenicol (94.28%), ampicillin (82.85%) and streptomycin (77.14%). The most prevalent resistance genotypes were tetA (97.14%), floR (94.28%), blaTEM-1 (82.85%) and aadA1 (77.14%). In addition, among the MDR Salmonella, 20% were positive for class 1 integron gene (intl1). As far as we know, this is the first study describing the molecular basis of antibiotic resistance in MDR Salmonella from broiler farms in Bangladesh. In addition to tetA, floR, blaTEM-1, aadA1 and intl1 were also detected in the isolated MDR Salmonella. The detection of MDR Salmonella in broiler chicken carrying intl1 is of serious public health concern because of their zoonotic nature and possibilities to enter into the food chain.

Molecular detection of multidrug and colistin-resistant Escherichia coli isolated from house flies in various environmental settings.

Aim: To detect antibiotic-resistant pathogenic Escherichia coli in house flies captured from various environmental settings. Materials & methods: Isolation and identification of E. coli was performed based on culture and PCR. Antimicrobial susceptibility testing was conducted using disk diffusion test. Detection of virulence and antimicrobial resistance genes was carried out using PCR methods. Results: The prevalence of E. coli in flies was 61% with highest in dairy farms (70.67%) followed by food centers (65.33%), dustbins (64%) and area close to hospital (44%). The prevalence rates of tetA, tetB, ereA, CITM, SHV, mcr-3 and catA1 resistance determinants were 88.75, 48.52, 41.67, 37.17, 27.77, 18.37 and 14.81%, respectively. Conclusion: Multidrug-resistant pathogenic E. coli are widely distributed in house flies, which requires a one-health approach to delineate their control.

Molecular Detection and Antibiotyping of Multidrug-Resistant Salmonella Isolated from Houseflies in a Fish Market.

Houseflies (Musca domestica) are well-known mechanical vectors for spreading multidrug-resistant bacteria. Fish sold in open markets are exposed to houseflies. The present study investigated the prevalence and antibiotypes of multidrug-resistant (MDR) Salmonella spp. in houseflies captured from a fish market. Direct interviews with fish vendors and consumers were also performed to draw their perceptions about the role of flies in spreading antibiotic-resistant bacteria. A total of 60 houseflies were captured from a local fish market in Bangladesh. The presence of Salmonella spp. was confirmed using PCR method. Antibiogram was determined by the disk diffusion method, followed by the detection of tetA, tetB, and qnrA resistance genes by PCR. From the interview, it was found that most of the consumers and vendors were not aware of antibiotic resistance, but reported that flies can carry pathogens. Salmonella spp. were identified from the surface of 34 (56.7%) houseflies, of which 31 (91.2%) were found to be MDR. This study revealed 25 antibiotypes among the isolated Salmonella spp. All tested isolates were found to be resistant to tetracycline. tetA and tetB were detected in 100% and 47.1% of the isolates, respectively. Among the 10 isolates phenotypically found resistant to ciprofloxacin, six (60%) were found to be positive for qnrA gene. As far as we know, this is the first study from Bangladesh to report and describe the molecular detection of multidrug-resistant Salmonella spp. in houseflies in a fish market facility. The occurrence of a high level of MDR Salmonella in houseflies in the fish market is of great public health concerns.