Comparison of controlling capabilities of lactobionic acid, nisin, and K-Sorbate against dairy-borne Staphylococcus aureus, Escherichia coli, and mold in soft cheese.

Background: The utilization of chemical preservatives holds the promise of effectively controlling microbial growth in soft cheese. Aim: The first trial aimed to compare the effectiveness of lactobionic acid (LBA) and K-Sorbate in controlling the proliferation of Staphylococcus aureus, Escherichia coli, and mold in white soft cheese. The subsequent part of the study explored the inhibitory effects of K-Sorbate, nisin, and LBA on mold populations in cheese whey. Methods: Two sets of soft cheese were produced. One set was contaminated with S. aureus, while the other was with E. coli, each at concentrations of 1 log CFU/ml and 1 log CFU/100 ml. Different concentrations of LBA were incorporated into these sets of cheese. Similar cheese samples were treated with K-Sorbate. For the subsequent part of the study, it was manufactured and divided into groups that inoculated with LBA with different concentrations, K-Sorbate, and nisin. Results: With higher S. aureus inoculation, by day 18, the positive control exhibited growth exceeding 5 log CFU/g. In contrast, the LBA treatment dropped below limit of detection (LOD) and K-Sorbate yielded 4.8 log CFU/g. While with lower S. aureus inoculation, the positive control reached log CFU/g, while LBA treatment fell below LOD by day 14, and K-Sorbate reached 2.9 log CFU/g. For E. coli inoculation, with higher concentrations, by day 18, the positive control exceeded 5 log CFU/g. Conversely, LBA treatment greatly decreased and K-Sorbate treatment measured 5.1 log CFU/g. With lower E. coli concentrations, the positive control surpassed 3 log CFU/g, yet LBA treatment dropped below LOD by day 3. Mold counts indicated some inhibition with the K-Sorbate treatment, while control groups showed growth. LBA treatments exhibit noticeable growth inhibition. About the other part of the study, the outcomes demonstrated that while growth of mold occurred in the control group, inhibitory effects were apparent in the treatment groups, and significant distinctions existed between K-Sorbate, nisin, LBA treatments, and the control group. Conclusion: Our findings suggest that LBA has the potential to effectively control the growth of E. coli, S. aureus, and mold in soft cheese. Moreover, LBA displays greater preservative efficacy compared to K-Sorbate and nisin.

Beneficial effect of probiotics supplementation on quality of edible fresh table eggs during storage.

Background: This study discussed the effect of probiotic supplementation on laying hens' diets and the enhancement of egg quality during the cold storage period. Aim: To study the efficacy of the addition of probiotics to hen diets in terms of improving the egg's quality during the cold storage period and protection against enteric pathogens. Methods: 100 table eggs were collected from farms of laying hens on a battery system, 46 weeks old HylineW36 white in Sharkia Government. The collected eggs were separated into 2 groups (50 each); the control group from hens fed on diets without probiotics, and the probiotic group from hens fed on diets with (100 g/ton) of supplemented probiotics preparation. All groups were separated into 5 sub-groups for the examinations; on the fresh day, 7th, 14th, 21st, and 28th days on cold storage at 4°C. Chemical, physical, and microbiological examinations were done for internal egg contents and eggshells. Results: Our results showed that probiotics supplements have advantageous effects on the quality of eggs during cold storage periods. Also, microbiological examination proved that eggshells from hens fed on diets with probiotics supplemented (100 g/ton) have decreased the level of bacterial contamination with Salmonella and Escherichia coli than hens fed on a regular diet. Conclusion: It could be shown that the probiotics supplementation may decrease and reduce the effect of the storage period on the quality of shell, albumen, and yolk.

Occurrence and D-Tryptophan Application for Controlling the Growth of Multidrug-Resistant Non-O157 Shiga Toxin-Producing Escherichia coli in Dairy Products.

The objectives of the current study were first to determine the prevalence of non O157:H7E. coli, especially Shiga toxin-producing Escherichia coli (STEC) in retailed milk and dairy products in Egypt. Second, the antimicrobial resistance profiling and virulence genes of the isolated E. coli strains were screened. Third, evaluation of the inhibitory effects of D-tryptophan against E. coli O26:H11 was further performed. The results revealed that 20% (30/150) of the samples were STEC positive, with 64 isolates harboring some virulent genes, such as Stx1, Stx2, eaeA, and hylA. Serological identification revealed four different pathotypes belonging to EPEC, ETEC, EHEC, and EIEC. Antimicrobial susceptibility testing revealed that 100%, 98.44%, 92.19%, 71.87%, 65.63% and 64.06% of the isolates had a resistance against tetracycline, oxacillin, erythromycin, nalidixic acid, sulphamethoxazol, and ampicillin, respectively. D-tryptophan addition (40 mM) to E. coli O26:H11-inoculated soft cheese and ice cream revealed a significant reduction (p < 0.05) in bacterial growth, especially when accompanied with other food stressors. D-Tryptophan is considered as an effective food preservative and as a promising alternative candidate in the dairy industry.

An estimation of staffing requirements in primary care in Oman using the Workload Indicators of Staffing Needs method.

BACKGROUND: Oman is a high-income country having a relatively small population scattered over large sparsely populated areas. This presents challenges to the provision of health services. It is important to ensure that all health facilities at all levels of care have the right number and skills mix of health workers to deliver quality health care. AIMS: The main aim was to develop national staffing norms to ensure adequate numbers, appropriate skills mix and equitable distribution of health professionals in primary health care (PHC) using the workload indicators of staffing needs (WISN) method. METHODS: All types of PHC services were itemized (promotive, preventive, curative, and rehabilitative and support services). We used 2014 data from the health information system and the human resources management information system to develop staffing norms using the WISN method. First we set the norms based on the national average for the activity standards, then simulated the norms in Muscat governorate, which has 32% of the population. RESULTS: We calculated the required numbers of GPs and specialists for PHC centres providing core as well as core and supplementary services and the expected annual outpatient attendance. The simulation showed that doctors were less workload stressed (WISN ratio 1.02) than nurses (WISN ratio 0.66) on average, although some variations between health centres were noted. CONCLUSIONS: Additional parameters (e.g. planned new services; local disease profile; change in health policies) may be added in future to re-adjust the calculation method once the health services mapping and human resources for health profiles for each governorate is completed.

SafetyNET Community-based patient safety initiatives: development and application of a Patient Safety and Quality Improvement Survey.

OBJECTIVES: To: 1) develop/adapt and validate an instrument to measure patient safety attitudes and opinions of community-based spinal manipulative therapy (SMT) providers; 2) implement the instrument; and 3) compare results among healthcare professions. METHODS: A review of the literature and content validation were used for the survey development. Community-based chiropractors and physiotherapists in 4 Canadian provinces were invited. RESULTS: The Agency for Healthcare Research and Quality's (AHRQ) Medical Office Survey on Patient Safety Culture was the preferred instrument. The survey was modified and validated, measuring 14 patient safety dimensions. 276 SMT providers volunteered to respond to the survey. Generally, SMT providers had similar or better patient safety dimension scores compared to the AHRQ 2016 medical offices database. DISCUSSION: We developed the first instrument measuring patient safety attitudes and opinions of community-based SMT providers. This instrument provides understanding of SMT providers' opinions and attitudes on patient safety and identifies potential areas for improvement.

OBJECTIFS: 1) Élaborer/adapter et valider un instrument servant à évaluer les attitudes à l'égard de la sécurité du patient et les opinions des praticiens effectuant des manipulations vertébrales (MV); 2) adopter cet instrument; et 3) comparer les résultats obtenus entre les professionnels de la santé. MÉTHODOLOGIE: Pour élaborer le sondage, on a revu la littérature, on a validé le contenu et on a invité des chiropraticiens et des physiothérapeutes de quatre provinces canadiennes à participer. RÉSULTATS: Le Medical Office Survey on Patient Safety Culture de l'Agency for Healthcare Research and Quality's (AHRQ) était l'instrument préféré. Le sondage a été modifié et validé et a servi à mesurer 14 aspects de la sécurité du patient. 276 professionnels effectuant des MV ont accepté de répondre au sondage. En règle générale, les cotes obtenues chez les professionnels effectuant des MV pour ce qui des aspects de la sécurité étaient comparables ou meilleurs que celles des professionnels de la santé enregistrés dans la base de données de 2016 de l'AHRQ. DISCUSSION: On a élaboré le premier instrument servant à évaluer les attitudes à l'égard de la sécurité et les opinions des praticiens effectuant des MV dans une collectivité. Cet instrument permet de comprendre les opinions et les attitudes à l'égard de la sécurité du patient des professionnels effectuant des MV et de cerner les aspects qui pourraient être améliorés.

A rare highly aggressive tumour: lymphoepithelioma-like thymic carcinoma.

Lymphoepithelioma-likethymic carcinoma is a rare neoplasm that presents with compressive symptoms or as an incidental radiological finding of an anterior mediastinal mass. It is an aggressive carcinoma with a high rate of invasion, metastasis and recurrence. Its diagnosis usually carries a poor prognosis largely due to propensity for late diagnosis. To date, guidance for treatment remains limited. This is a case of lymphoepithelioma-like thymic carcinoma in a young male adult who presented initially with back pain. Despite prompt initiation of chemotherapy with cisplatin, doxorubicin and cyclophosphamide, he had a complicated hospital course leading to demise within 2 months of diagnosis.

Maintaining low non-neoplastic polypectomy rates in high-quality screening colonoscopy.

BACKGROUND AND AIMS: Non-neoplastic polypectomies (NNPs) add pathology and procedural costs but do not reduce cancer risk and should be minimized. We sought to define the minimal non-neoplastic polypectomy rate (NNPR) for those colonoscopists achieving high-quality colorectal cancer screening based on adenoma detection rates (ADRs). METHODS: NNPRs for colonoscopists achieving high-quality adenoma detection rates were reported to determine minimal NNPR goals. Two approaches to tracking NNPR monitoring were compared: (1) total NNPR, an NNPR inclusive of all non-neoplastic specimens with exclusion of only hyperplastic polyp, sessile serrated polyp, and adenoma; and (2) normal tissue-only NNPR, an NNPR inclusive of those specimens with only normal colonic mucosa or lymphoid follicles. RESULTS: For those performing colonoscopy with high-quality ADRs (≥25%), half (6/12) of the colonoscopists had a total NNPR of ≤8.5% and 2 gastroenterologists had a total NNPR of ≤3.4%. The mean total NNPR of the cohort was 8.7% versus the normal tissue only NNPR, which was 7.5% (mean difference of 1.2%, standard deviation ± 0.97). The widest variation between total NNPR versus normal tissue only NNPR for any colonoscopist was 2.9%. The total NNPR ranged between 2.6% and 21.3% among 14 colonoscopists. CONCLUSIONS: Colonoscopy with a high-quality ADR can be achieved while maintaining a low total NNPR. A total NNPR, inclusive of all non-neoplastic specimens as an alternative to an approach in which all specimens require individual review in order to select out only normal tissue can be considered for monitoring of NNPR.

Structure and Compressive Properties of Invar-Cenosphere Syntactic Foams.

The present study investigates the mechanical performance of syntactic foams produced by means of the metal powder injection molding process having an Invar (FeNi36) matrix and including cenospheres as hollow particles at weight fractions (wt.%) of 5 and 10, respectively, corresponding to approximately 41.6 and 60.0 vol.% in relation to the metal content and at 0.6 g/cm³ hollow particle density. The synthesis process results in survival of cenospheres and provides low density syntactic foams. The microstructure of the materials is investigated as well as the mechanical performance under quasi-static and high strain rate compressive loads. The compressive stress-strain curves of syntactic foams reveal a continuous strain hardening behavior in the plastic region, followed by a densification region. The results reveal a strain rate sensitivity in cenosphere-based Invar matrix syntactic foams. Differences in properties between cenosphere- and glass microsphere-based materials are discussed in relation to the findings of microstructural investigations. Cenospheres present a viable choice as filler material in iron-based syntactic foams due to their higher thermal stability compared to glass microspheres.

Single-Site Robotic Cholecystectomy: The Timeline of Progress.

AIM: To investigate the learning curve and perioperative outcomes of single-site robotic cholecystectomy during the first 102 cases by a single surgeon. MATERIALS AND METHODS: A retrospective review of a prospectively maintained database was performed on the first 102 cases of single-site robotic cholecystectomy. Patients were divided into five chronological groups based on the date of surgery, with 20 patients in each group except the 5th group which had 22 patients. The groups were compared by docking time, robotic dissection time, and overall surgery time. A P value of 0.05 was used as statistically significant. RESULTS: The female to male ratio was 2:1. The mean age was 51 years (18-87) and the mean BMI was 28.26 (18-41). Overall, 69 % of the patients underwent elective cholecystectomy and 31 % required urgent surgery. In all, 17 % of patients had previous abdominal surgeries. In total, 45 % of procedures were regarded as same day surgery. The total mean length of stay was 1.97 days (0-8). The mean operative time was 110 min (36-265), mean robotic console time 70 min (26-179), and mean docking time 9 min (1-26). The overall conversion rate was 3.9 % and the complication rate was 4 %. The docking time, robotic time, and average operative time were significantly different in the first group as compared to the remaining the five groups (P = 0.001). CONCLUSION: Single-site robotic cholecystectomy is safe in both elective and urgent conditions, and in patients with previous abdominal surgeries. It has a short learning curve.

Association between left atrial appendage morphology evaluated by trans-esophageal echocardiography and ischemic cerebral stroke in patients with atrial fibrillation.

The left atrial appendage (LAA) represents one of the major sources of cardiac thrombi responsible for embolic stroke in patients with atrial fibrillation (AF). The aim of the present study was to evaluate LAA structure and functions by transesophageal echocardiography (TEE) in patients with AF to investigate the possible association between the different LAA morphologies and the patients' history of ischemic cerebral stroke. We included 50 patients with non-valvular AF (29 chronic, 21 paroxysmal), 24 patients (13 men) without stroke; and 26 patients (9 men) with a history of ischemic stroke. All patients underwent TEE evaluation of LAA morphology and functions. Compared to patients without stroke, patients with ischemic stroke had significantly higher CHADS2 scores (4.19 ± 0.89 versus 1.67 ± 1.13; P < 0.001) and C-reactive protein levels (8.3 ± 1.6 versus 7.6 ± 0.83 mg/L; P = 0.023), and lower peak filling (21.7 ± 11.3 versus 31.2 ± 9.5 cm/second; P = 0.033) and emptying (22.2 ± 9.7 versus 33.4 ± 13.4 cm/second, P = 0.030) velocities. Triangular LAA morphology had a higher prevalence in patients with stroke (36% versus 12% in non-stroke group); and in half of them an LAA thrombus was present. LAA thrombi were detected in 9 patients (18%) with stroke and in 5 patients (10%) without stroke. On multivariate logistic regression analysis, age (OR = 1.202 [1.042-1.585]; P = 0.041), LAA orifice diameter (OR = 1.275 [1.102-1.748]; P = 0.028), and triangular LAA morphology (OR = 4.53 [1.629-8.381]; P = 0.011) were significantly and independently associated with ischemic stroke in AF patients. LAA morphology evaluated by TEE may be useful for predicting ischemic cerebral stroke in patients with non-valvular AF, especially in those with a low CHADS2 score.

Assessment of a regulatory sanitization process in Egyptian dairy plants in regard to the adherence of some food-borne pathogens and their biofilms.

Food-borne pathogens may develop certain strategies that enable them to defy harsh conditions such as chemical sanitization. Biofilm formation represents a prominent one among those adopted strategies, by which food-borne pathogens protect themselves against external threats. Thus, bacterial biofilm is considered as a major hazard for safe food production. This study was designed to investigate the adherence and the biofilm formation ability of some food-borne pathogens on stainless steel and polypropylene surfaces using chip assay, and to validate regular sanitizing process (sodium hypochlorite 250 mg/L) for effective elimination of those pathogens. Sixteen pathogenic bacterial strains, previously isolated from raw milk and dairy products at Zagazig city, Egypt (9 Staphylococcus aureus, 4 Cronobacter sakazakii and 3 Salmonella enterica serovar Typhimurium), were chosen for this study. Strains showed different patterns of adherence and biofilm formation on tested surfaces with minor significance between surfaces. The ability of sodium hypochlorite to completely eradicate either adhered or biofilm-embedded pathogens varied significantly depending on the strain and type of surface used. Whilst, sodium hypochlorite reduced tested pathogens counts per cm² of produced biofilms, but it was not able to entirely eliminate neither them nor adherent Cronobacter sakazakii to stainless steel surface. This study revealed that biofilm is considered as a sustainable source of contamination of dairy products with these pathogens, and also emphasized the need of paying more attention to the cleaning and sanitizing processes of food contact surfaces.

In vitro inhibition of expression of virulence genes responsible for colonization and systemic spread of enteric pathogens using Bifidobacterium bifidum secreted molecules.

Enteric pathogens such as Salmonella enterica serovar Typhimurium and Enterohaemorrhagic Escherichia coli require an initial indispensable step of attachment or invasion of enterocytes before they can produce systemic disease and translocate to their target organs. Prevention of either of these steps will result in an avirulent state and limit their pathogenicity. In vitro tests demonstrated that molecules secreted by Bifidobacterium bifidum interfere with both attachment and invasion. The main regulatory genes controlling the virulence factors essential for these pathogenicity steps were efficiently down-regulated when treated with chromatographically separated B. bifidum cell free fractions as measured by reporter constructs and confirmed by RT-PCR. Moreover, the ability of both pathogens to colonize eukaryotic cells was significantly reduced, and the capacity of Salmonella to survive and multiply within macrophages was also diminished upon treatment with these bioactive molecules. These results indicate that probiotic Bifidobacteria strains may represent an effective alternative approach to control food-borne enteric pathogens.

Multivascular Doppler surveillance in high risk pregnancies.

OBJECTIVES: Analysis of fetal arterial and venous Doppler predictability for adverse perinatal outcome. METHODS: Blood flow in the uterine, umbilical and middle cerebral arteries, umbilical vein, ductus venosus and Galen vein were examined with in 72 h of delivery in 88 high-risk pregnancies. The managing clinicians were only informed about the results of the umbilical artery Doppler. The Doppler results were correlated to adverse perinatal outcome. RESULTS: Doppler abnormalities were seen in both preterm and term pregnancies. Umbilical venous pulsations (n = 13) were strongly correlated to Apgar score <7 at 5 min, abnormal blood gases, need for ventilation assistance and operative delivery for fetal distress. Twenty-four fetuses had brain sparing in the middle cerebral artery, and forty-five had abnormal umbilical artery Doppler. These were correlated to admission in the neonatal intensive care unit, operative delivery and prematurity. Brain sparing in middle cerebral artery was also correlated to ventilation disturbances in the newborns. Abnormal ductus venosus blood velocity was only seen in 9 cases and not related to adverse outcome. Galen vein pulsations (n = 26) seem to appear earlier than pulsations in the umbilical vein and were not related to adverse outcome. conclusion: Umbilical vein pulsations were better correlated to adverse perinatal outcome than were other Doppler findings including ductus venosus.

Probiotics down-regulate genes in Salmonella enterica serovar typhimurium pathogenicity islands 1 and 2.

Salmonella Typhimurium pathogenesis relies mainly on the expression of genes of two pathogenicity islands, Salmonella pathogenicity islands 1 and 2 (SPI1 and SPI2). Each island has its own pattern of expression and regulation. Success in suppression of the responsible key activator of each island would be an effective way of controlling Salmonella, especially with the emerging problem of antibiotic-resistant strains. Probiotics have been shown to inhibit several foodborne pathogens, and their mode of action may partly involve down-regulation of virulence genes. To investigate whether probiotics played a role in the regulation of the pathogenicity islands SPI1 and SPI2 in Salmonella, two reporter strains were constructed in which the general regulator of SPI1, hilA, and the response regulator of SPI2, ssrB, were fused with luxCDABE genes. These constructs were used to screen the effect of probiotics on the expression of each gene. Molecules secreted by Bifidobacterium bifidum were able to down-regulate both genes.

Bilateral universal nephroblastomatosis in an 8-month-old infant treated with chemotherapy.

We report the case of an 8-month-old female infant presenting with bilateral, diffusely enlarged kidneys. A diagnosis of bilateral, universal nephroblastomatosis was made on tissue biopsies from both kidneys after correlation with the radiological findings. As far as we know, this is the oldest patient reported with this diagnosis in the English literature (they are usually younger than 4 months). The patient was treated with chemotherapy with very good response and almost 1 year later she is showing no signs of recurrence of her disease.