Risk of colorectal cancer due to Streptococcus gallolyticus: a systematic review.

INTRODUCTION: World Health Organization (2019) has declared colorectal cancer (CRC) as the second most common cancer in females and third in males, where the incidence seems to rise year by year. One of the very few potential pathogens specifically associated with malignant colonic diseases is Streptococcus gallolyticus (Sg). Sg is a part of the intestinal flora which formerly known as biotype I of Streptococcus bovis, belongs to Group D streptococci. Owing to only a few researches done in determining evidence to support Sg as a determinant of CRC, a systematic review is constructed. MATERIALS AND METHODS: Full-text articles on case-control and cohort studies published from 1st January 2010 to 1st October 2020 were searched using Google Scholar, PubMed and JSTOR. People of all age groups and Sg bacteraemia or colonisation were the type of participant and exposure used for the search strategy, respectively. Data collection was done by three reviewers and checked by two reviewers for discrepancies. All the papers were critically appraised using the STROBE statement. Qualitative synthesis was done by descriptive comparison, distribution of Sg according to stage comparison, method used for Sg detection comparison and risk of bias comparison. RESULT: Seven out of 11 articles that fulfil the eligibility criteria were selected. Four papers have low overall risk of bias due to low confounding or selection bias. Sg is found to be a risk factor for CRC from three papers studied, whereas the other four papers did not include the strength of association. Only two papers studied the association between the distribution of Sg and stages of CRC, where the results were contradictory from each other, making it to be inconclusive. The most common method used for Sg detection is a culturing technique, followed by molecular and biochemical techniques. CONCLUSION: There is insufficient evidence to prove the association between Sg bacteraemia as the risk factor for CRC as well as the association between the Sg distribution and stages of CRC. Culturing technique is the most common method used for the detection of bacteria, but it requires subsequent investigations to confirm the presence of Sg. Thus, it is recommended that more studies need to be done using strong statistical analysis to control for most of the confounders with comprehensive explanation and use of more methods in the detection of Sg.

Placenta microRNA profile of patient with Obstetric Antiphospholipid Syndrome.

The onset of obstetric antiphospholipid syndrome (APS) occurs when antiphospholipid antibodies act upon the placenta. During pregnancy, APS exhibits traits such as vascular thrombosis, inflammation, and hindered trophoblast implantation. The involvement of microRNA expression has been proposed as a genetic factor contributing to the syndrome's development. MicroRNAs play a role in regulating gene expression in various cellular processes, including the formation of placental tissue. Therefore, additional research is needed to explore the control of placental miRNA in APS. In this study, we aimed to profile miRNA expressions from placenta tissue of patients with APS. Differentially expressed miRNAs were determined for its targeted genes and pathways. Agilent microarray platform was used to measure placental microRNA expressions between normal placental tissue and those obtained from patients with APS. Differentially expressed miRNAs were detected using GeneSpring GX software 14.2 and sequences were mapped using TargetScan software to generate the predicted target genes. Pathway analysis for the genes was then performed on PANTHER and REACTOME software. Selected miRNAs and their associated genes of interest were validated using qPCR. Microarray findings revealed, 9 downregulated and 21 upregulated miRNAs expressed in placenta of patients with APS. Quantitative expressions of 3 selected miRNAs were in agreement with the microarray findings, however only miR-525-5p expression was statistically significant. Pathway analysis revealed that the targeted genes of differentially expressed miRNAs were involved in several hypothesised signalling pathways such as the vascular endothelial (VE) growth factor (VEGF) and inflammatory pathways. VE-cadherin, ras homolog member A (RHOA) and tyrosine kinase receptor (KIT) showed significant downregulation while Retinoblastoma gene (RET), Dual specificity protein phosphatase 10 (DUSP10) and B-lymphocyte kinase (BLK) genes were significantly upregulated. These preliminary findings suggest the involvement of miRNAs and identified novel associated genes involvement in the mechanism of obstetric APS, particularly through the alteration of vascular-associated regulators and the inflammatory signalling cascade.

BrainGAN: Brain MRI Image Generation and Classification Framework Using GAN Architectures and CNN Models.

Deep learning models have been used in several domains, however, adjusting is still required to be applied in sensitive areas such as medical imaging. As the use of technology in the medical domain is needed because of the time limit, the level of accuracy assures trustworthiness. Because of privacy concerns, machine learning applications in the medical field are unable to use medical data. For example, the lack of brain MRI images makes it difficult to classify brain tumors using image-based classification. The solution to this challenge was achieved through the application of Generative Adversarial Network (GAN)-based augmentation techniques. Deep Convolutional GAN (DCGAN) and Vanilla GAN are two examples of GAN architectures used for image generation. In this paper, a framework, denoted as BrainGAN, for generating and classifying brain MRI images using GAN architectures and deep learning models was proposed. Consequently, this study proposed an automatic way to check that generated images are satisfactory. It uses three models: CNN, MobileNetV2, and ResNet152V2. Training the deep transfer models with images made by Vanilla GAN and DCGAN, and then evaluating their performance on a test set composed of real brain MRI images. From the results of the experiment, it was found that the ResNet152V2 model outperformed the other two models. The ResNet152V2 achieved 99.09% accuracy, 99.12% precision, 99.08% recall, 99.51% area under the curve (AUC), and 0.196 loss based on the brain MRI images generated by DCGAN architecture.

Factors associated with unsuccessful quitters in stop smoking services in Perlis, Malaysia.

INTRODUCTION: Tobacco smoking is one of major risk factor of non-communicable disease worldwide. As a prevention strategy, stop smoking services has been advocated at primary care. However, evidence suggests that worldwide there is high rate of unsuccessful quitters. In Malaysia, such evidence has come from small studies or single site study, and evidence on factors associated with failure to quit is scarce. This study aimed to identify the factors associated with unsuccessful quitters among smokers in Stop Smoking Services provided by government health clinics at North Peninsular of Malaysia. MATERIALS AND METHODS: This was a retrospective study record review using data from the Stop Smoking Services registry and patient file card between January 2017 and Jun 2019. Independent variables included in this analysis are sociodemographic data, comorbidity, number appointments attended, duration of smoking, age of starting smoking, previous attempt to quit, fagerstrom score and type of treatment. The outcome of interest, is unsuccessful quitters defined as those who continued to smoke at 6 months after attending the service. A total of 427 sample randomly cases selected from 490 eligible sample was analysed. Logistic regression was used to model factors associated with unsuccessful quitters. RESULTS: The study suggested that clients who attended 0-3 clinic sessions (AdjOR 6.57; 95% CI: 4.14, 10.43) and being single, unmarried (AdjOR: 2.78; 95%CI: 1.07, 7.18) was associated with increased risk of being unsuccessful quitters among smokers in Northern state of Malaysia CONCLUSION: The number of clinic sessions attended and marital status were factors associated with unsuccessful quitters among smokers in the State of Perlis, of Malaysia.

Rural child malnutrition and unsuccessful outcome of food basket programme: does ethnicity matter?

Objectives: The objectives of this study were to determine the prevalence of malnutrition among five-year-olds and factors associated with unsuccessful outcome of a Food Basket Programme (FBP) in a rural district of Kelantan, Malaysia.Design: Administrative health records from selected health clinics were reviewed. Study sample includes indigenous population or Orang Asli of Malaysia. Unsuccessful outcome was defined according to failure to complete the programme according to growth gain and on-time. Multiple logistics regression was used to assess the associated factors of unsuccessful outcome of FBP.Results: This study showed that the prevalence rates of malnutrition among children below five years old were 34.2% underweight, 16.4% thinness, 32.5% stunting and 3.0% overweight, with Orang Asli children faring the worse. Orang Asli children were also five times more likely to be unsuccessful in the FBP (p < .001).Conclusion: Malnutrition is still prevalent among children below five years old in this rural setting and Orang Asli children are vulnerable to have an unsuccessful outcome from the Food Basket Programme. Further research is necessary to further explain this association to inform policy, specifically for Orang Asli children.

Evaluation of Serum Free Light Chain in Diagnosis and Monitoring of Plasma Cell Disorders.

OBJECTIVE: To determine diagnostic accuracy of serum free light chain assay compared to serum and urine protein electrophoresis in plasma cell disorders. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: This study was conducted in the Immunology Department, Armed Forces institute of Pathology (AFIP), Rawalpindi, from May 2017 to May 2018. METHODOLOGY: Patients referred to AFIP for diagnosis of plasma cell disorders or for monitoring while receiving treatment were included in study. They were tested for serum protein electrophoresis (SPE), urine protein electrophoresis (UPE), immunofixation (IF), and serum free light chain assay (sFLC). IF was used as the reference standard. Test results were compared in terms of sensitivity, specificity, positive or negative predictive value, and accuracy index. RESULTS: During the study period 220 patients were tested for plasma cell disorders. One hundred and sixty-seven patients tested positive. One hundred twenty-nine patients had multiple myeloma, 13 plasmacytoma, 11 monoclonal gammopathy of undetermined significance, 6 amyloidosis, 6 POEMS, and 2 Waldenstrom macroglobulinemia. SPE had a sensitivity of 70.5%, specificity of 100%; sFLC had a sensitivity of 87%, specificity of 81%; and UPE had a sensitivity of 23.5%, specificity of 97%. Accuracy index was 80.5% for SPE, 85% for sFLC, and 54% for UPE. When taken together, SPE and UPE had a combined sensitivity of 72%, specificity 97%, and accuracy index 80.5%. SPE and sFLC had combined sensitivity of 98.6%, specificity 84.3%, and accuracy index 94%. CONCLUSION: Combination of SPE and sFLC had the highest sensitivity and accuracy index for diagnosis and monitoring of plasma cell disorders compared with conventional tests.

Novel N-substituted 5-aminosalicylamides as dual inhibitors of cyclooxygenase and 5-lipoxygenase enzymes: Synthesis, biological evaluation and docking study.

Three new series of 5-aminosalicylic acid derivatives; series I (14, 16-18), series II (19-30) and series III (31-41) were synthesized as potential dual COX-2/5-LOX inhibitors. Their chemical structures were confirmed using spectroscopic tools including IR, 1H NMR, 13C NMR, mass spectroscopy and elemental analyses. The anti-inflammatory activity for all target compounds was evaluated in vivo using carrageenan-induced paw edema. Compound 36 showed the highest anti-inflammatory activity (114.12%) relative to reference drug indomethacin at 4 h interval. Selected derivatives were evaluated in vitro to inhibit ovine COX-1, human recombinant COX-2 and 5-LOX enzymes. Compounds 34 &35 exhibited significant COX-2 inhibition (IC50 = 0.10 µM) with significant COX-2 selectivity indices (SI = 135 & 145 respectively) approximate to celecoxib (IC50 = 0.049 µM, SI = 308.16) and exceeding indomethacin (IC50 = 0.51 µM, SI = 0.08). Interestingly, all compounds showed superior 5-LOX inhibitory activity about 2-5 times relative to zileuton. Compound 16 was the superlative 5-LOX inhibitor that revealed (IC50 = 3.41 µM) relative to zileuton (IC50 = 15.6 µM). Compounds 34, 35, 36 and 41 showed significant dual COX-2/5-LOX inhibitions. The gastric ulcerogenic effect of compound 36 was examined on gastric mucosa of albino rats and they showed superior GI safety profile compared with indomethacin. Molecular docking studies of the compounds into the binding sites of COX-1, COX-2 and 5-LOX allowed us to shed light on the binding mode of these novels dual COX and 5-LOX inhibitors.

Prevalence of Clostridium difficile infection and colonization in a tertiary hospital and elderly community of North-Eastern Peninsular Malaysia.

Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P < 0·05). Absence of these factors was a possible reason for low colonization in the community. Only 3% of 154 respondents answered all questions correctly in the awareness survey. C. difficile colonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.

The effect of co-administration of Lawsonia inermis extract and octreotide on experimental hepatocellular carcinoma.

OBJECTIVES: To investigate the effect of Lawsonia inermis total methanolic extract (LIE) and octreotide (OC) on hepatocellular carcinoma (HCC) progression, depending on somatostatin receptor 2 (SSTR-2) and Alfa fetoprotein (AFP) perturbations. METHODS: Sixty albino mice, divided into five groups (12/each); all except control were injected with single diethyl nitrosamine (DENA) dose of 90 mg/kg body weight, intraperitoneally (IP). DENA group was killed at the last day of week 18. LIE group was given 200 mg/100 ml drinking water from first day of DENA injection until end of week 18. OC group received OC (0.1 mg/kg body weight, twice daily by subcutaneous injection, SC from the first day of week 17 till end of week 18. LIE + OC was given medications till the last day of week 18. Serum AFP, liver tissue SSTR-2 mRNA, its protein expression, reduced glutathione (GSH) and malondialdehyde (MDA) were analyzed. RESULTS: A significant increase in plasma AFP and hepatic mRNA, associated to liver tissue neoplastic changes, SSTR-2 expression and MDA with decreased hepatic GSH were observed in DENA group. These changes were significantly improved by LIE and/or OC. CONCLUSIONS: LIE and/or OC treatment has effective chemopreventive action due to their ability to alleviate oxidative stress, desensitizing cellular growth receptor to SST.

Hepatic somatostatin receptor 2 expression during premalignant stages of hepatocellular carcinoma.

Growth and antigrowth hormones were occasionally investigated in hepatocarcinoma. Somatostatin regulates cell proliferation and inhibits the secretion of many growth factors engaged to tumors through a group of receptors, including somatostatin receptor type 2 (SSTR2). Caspase-3 is a transcription factor which is elevated in liver cancers. The most commonly approved marker for liver cancer is alpha fetoprotein (AFP), although it has no more than 65% sensitivity and specificity. Hepatocarcinoma is also mediated by oxidative stress. Four groups of mice were used in this work: a control group and another three groups (Gp 2, 3, and 4) used for induction of HCC with a single subnecrotic dose of diethylnitrosamine (DENA). Gp 2 was sacrificed on the last day after 8 weeks, Gp 3 after 16 weeks, and Gp 4 after 24 weeks. Both liver tissue SSR2 protein and mRNA, liver AFP, and caspase-3 mRNA expression, concomitant to tissue malondialdehyde (MDA), were significantly elevated with depressed reduced glutathione (GSH). The change was much more prominent and stage dependent for SSR2. These effects were supported by graded histological abnormalities. The study encourages the use of liver tissue SSR2 protein and mRNA as a reliable tumor marker for liver cancer rather than AFP which is always misleading during silent stages of hepatocarcinogenesis.

Discovery of new HER2/EGFR dual kinase inhibitors based on the anilinoquinazoline scaffold as potential anti-cancer agents.

Herein, we designed and synthesized certain anilinoquinazoline derivatives bearing bulky arylpyridinyl, arylpropenoyl and arylpyrazolyl moieties at the 4' position of the anilinoquinazoline, as potential dual HER2/EGFR kinase inhibitors. A detailed molecular modeling study was performed by docking the synthesized compounds in the active site of the epidermal growth factor receptor (EGFR). The synthesized compounds were further tested for their inhibitory activity on EGFR and HER2 tyrosine kinases. The aryl 2-imino-1,2-dihydropyridine derivatives 5d and 5e displayed the most potent inhibitory activity on EGFR with IC50 equal to 2.09 and 1.94 µM, respectively, and with IC50 equal to 3.98 and 1.04 µM on HER2, respectively. Furthermore, the anti-proliferative activity of these most active compounds on MDA-MB-231 breast cancer cell lines, known to overexpress EGFR, showed an IC50 range of 2.4 and 2.5 µM, respectively.

Classical Galactosaemia in Ireland: incidence, complications and outcomes of treatment.

Newborn screening for the inborn error of metabolism, classical galactosaemia prevents life-threatening complications in the neonatal period. It does not however influence the development of long-term complications and the complex pathophysiology of this rare disease remains poorly understood. The objective of this study was to report the development of a healthcare database (using Distiller Version 2.1) to review the epidemiology of classical galactosaemia in Ireland since initiation of newborn screening in 1972 and the long-term clinical outcomes of all patients attending the National Centre for Inherited Metabolic Disorders (NCIMD). Since 1982, the average live birth incidence rate of classical galactosaemia in the total Irish population was approximately 1:16,476 births. This reflects a high incidence in the Irish 'Traveller' population, with an estimated birth incidence of 1:33,917 in the non-Traveller Irish population. Despite early initiation of treatment (dietary galactose restriction), the long-term outcomes of classical galactosaemia in the Irish patient population are poor; 30.6 % of patients ≥ 6 yrs have IQs <70, 49.6 % of patients ≥ 2.5 yrs have speech or language impairments and 91.2 % of females ≥ 13 yrs suffer from hypergonadotrophic hypogonadism (HH) possibly leading to decreased fertility. These findings are consistent with the international experience. This emphasizes the requirement for continued clinical research in this complex disorder.

Can methanolic extract of Nigella sativa seed affect glyco-regulatory enzymes in experimental hepatocellular carcinoma?

BACKGROUND AND AIM: To investigate the possible modulating role of "Nigella sativa" (NS), a plant commonly used in Egyptian traditional medicine, on premalignant perturbations in three glycol-regulatory enzymes in an experimental rat model of hepatocellular carcinoma (HCC). METHODS: Thirty-six (36) male albino rats were divided into four groups (n = 9). Group 1 served as a normal control, group 2 was treated with methanolic extract of Nigella sativa (MENS) (1 g/kg/day, orally) for 14 weeks, group 3 received a single intraperitoneal dose of diethyl nitrosamine (DENA) (200 mg/kg), followed 2 weeks later by a subcutaneous injection of carbon tetrachloride (CCl(4), 3 ml/kg/week/6 weeks) and group IV was treated with MENS for 2 weeks prior to administration of the carcinogenic combination (DENA + CCl(4), as in group 3) until the end of the experiment. The total period of the experiment was 14 weeks. RESULTS: In the DENA + CCl(4)-treated group, there was a significant increase in the relative liver weight, serum alpha fetoprotein level and the activities of hexokinase, glyceraldehyde phosphate dehydrogenase and glucose 6 phosphate dehydrogenase in both the serum and liver homogenate; this was accompanied by a subsequent decrease in body weight. Pre-treatment with MENS significantly maintained these parameters close to the normal condition. CONCLUSION: Based on these results, we conclude that MENS has a chemo-preventive effect against the progression into liver malignancy through its modulation of the energy metabolic pathways (i.e. glycolysis) that may be involved in hepatocarcinogenesis.

Starch-Based Polymer Materials as Advanced Adsorbents for Sustainable Water Treatment: Current Status, Challenges, and Future Perspectives.

Over the past three decades, chemical and biological water contamination has become a major concern, particularly in the industrialized world. Heavy metals, aromatic compounds, and dyes are among the harmful substances that contribute to water pollution, which jeopardies the human health. For this reason, it is of the utmost importance to locate methods for the cleanup of wastewater that are not genuinely effective. Owing to its non-toxicity, biodegradability, and biocompatibility, starch is a naturally occurring polysaccharide that scientists are looking into as a possible environmentally friendly material for sustainable water remediation. Starch could exhibit significant adsorption capabilities towards pollutants with the substitution of amide, amino, carboxyl, and other functional groups for hydroxyl groups. Starch derivatives may effectively remove contaminants such as oil, organic solvents, pesticides, heavy metals, dyes, and pharmaceutical pollutants by employing adsorption techniques at a rate greater than 90%. The maximal adsorption capacities of starch-based adsorbents for oil and organic solvents, pesticides, heavy metal ions, dyes, and pharmaceuticals are 13,000, 66, 2000, 25,000, and 782 mg/g, respectively. Although starch-based adsorbents have demonstrated a promising future for environmental wastewater treatment, additional research is required to optimize the technique before the starch-based adsorbent can be used in large-scale in situ wastewater treatment.

RNA-Seq reveals changes in human placental metabolism, transport and endocrinology across the first-second trimester transition.

The human placenta is exposed to major environmental changes towards the end of the first trimester associated with full onset of the maternal arterial placental circulation. Changes include a switch from histotrophic to hemotrophic nutrition, and a threefold rise in the intraplacental oxygen concentration. We evaluated their impact on trophoblast development and function using RNA-sequencing (RNA-Seq) and DNA-methylation analyses performed on the same chorionic villous samples at 7-8 (n=8) and 13-14 (n=6) weeks of gestation. Reads were adjusted for fetal sex. Most DEGs were associated with protein processing in the endoplasmic reticulum (ER), hormone secretion, transport, extracellular matrix, vasculogenesis, and reactive oxygen species metabolism. Transcripts higher in the first trimester were associated with synthesis and ER processing of peptide hormones, and glycolytic pathways. Transcripts encoding proteins mediating transport of oxygen, lipids, protein, glucose, and ions were significantly increased in the second trimester. The motifs of CBX3 and BCL6 were significantly overrepresented, indicating the involvement of these transcription factor networks in the regulation of trophoblast migration, proliferation and fusion. These findings are consistent with a high level of cell proliferation and hormone secretion by the early placenta to secure implantation in a physiological low-oxygen environment.

The regulation of cell proliferation by the papillomavirus early proteins.

The human papillomavirus (HPV) E6 and E7 oncogenes have direct effects on host cell proliferation. The viral E2 protein regulates transcription of E6 and E7 and thereby has an indirect effect on cell proliferation. In HPV-induced tumours, misappropriate random integration of the viral genome into the host chromosome often leads to disruption of the E2 gene and the loss of E2 expression. This results in cessation of the virus life cycle and the deregulation of E6 and E7 and is an important step in tumourigenesis. However, prior to these integration events, E2 can interact directly with the E6 and E7 proteins and modulate their activities. E2 also interacts with a variety of host proteins, including the p53 tumour suppressor protein. Here we outline evidence that suggests a role for E2 in the regulation of cell proliferation, and we discuss the importance of this regulation in viral infection and cervical tumourigenesis.

Impact of National Egyptian school feeding program on growth, development, and school achievement of school children.

BACKGROUND: School feeding program (SFP) increases access to education and to better health. This study aims to evaluate the effects of SFP on physical growth, cognitive development, psychosocial behavior, and learning achievement of school children. METHODS: A quasi-experimental study was conducted. The intervention group included 903 pupils in the fifth grade receiving the school meal, while the control group included 886 pupils, matched for age and sex, without meal. The meal consisted of a pie made of flour fortified with vitamins A, B6, B12, C, thiamin, riboflavin, niacin, folate, calcium, iron, zinc, and phosphorus. Socioeconomic position, nutritional status, and dietary behavior were evaluated. Neuropsychological tests were done. Psychosocial behavior was rated and educational achievement was recorded. Post hoc and independent sample t tests were used to detect the association of the studied parameters with the intake of school snack. RESULTS: Children who took the meal had better scores on visual memory, auditory vigilance tests (9.71 ± 2.80 vs. 7.45 ± 3.25; 25.02 ± 3.36 vs. 10.82 ± 8.92, respectively, P < 0.001), the afternoon attention and working memory test (8.20 ± 2.21vs. 7.75 ± 3.05) (P < 0.001), but less score of externalizing behavior (P < 0.001) than the control group. No significant changes of children's nutritional status were detected between the two groups. School meal was the main predictor of visual memory and auditory vigilance (P < 0.001), and was the strongest predictor of academic achievements when combined with family size and meals' frequency (P < 0.001). CONCLUSION: School meal improves academic achievements of school children.

Neurosurgically related nosocomial Acinetobacter baumannii meningitis: report of two cases and literature review.

Nosocomial meningitis is an uncommon complication of neurosurgical procedures, although nosocomial Gram-negative bacillary meningitis does occur occasionally in neurosurgical intensive care units (NSICUs). Acinetobacter baumannii is a rare cause of nosocomial meningitis, and is an even rarer cause of meningitis outbreaks in NSICUs. We report two cases of A. baumannii meningitis in an NSICU due to suboptimal aseptic technique in obtaining cerebrospinal fluid (CSF) specimens. After institution of infection control measures, i.e. aseptically collecting CSF specimens from distal external ventricular drain ports, there were no further cases. This report also reviews nosocomial Acinetobacter meningitis in adult neurosurgical patients.

Prepared for internship?

Preparedness of medical school graduates for the intern year is one of the emphasised objectives of undergraduate medical training. We have evaluated the perceived preparedness of graduates undertaking the intern year in the Republic of Ireland. A 9-page questionnaire was mailed to all 497 interns in Ireland following commencement of the intern year in July 2005. Data obtained included demographics, perceived preparedness and assessment of perceived clinical skills (four sub-domains: core competencies, communication, emergencies, and educational environment). Information on intern induction was also collected. 99 questionnaires were returned (19.9%). Most of the cohort were Irish and worked in large medical school teaching hospitals. The majority of interns felt 'unprepared' for the intern year. Interns perceived themselves 'poor' in all areas of clinical skills assessed. Intern induction was attended by the majority and most stated it was too short. Medical schools are actively seeking innovative methods, through early patient contact and sub-internships, to better prepare undergraduates for the intern year. The deficiencies identified in this study are significant and emphasise the need for continued reform in the undergraduate curriculum.

Bifidobacterium infantis M-63 improves mental health in victims with irritable bowel syndrome developed after a major flood disaster.

Individuals in a community who developed irritable bowel syndrome (IBS) after major floods have significant mental health impairment. We aimed to determine if Bifidobacterium infantis M-63 was effective in improving symptoms, psychology and quality of life measures in flood-affected individuals with IBS and if the improvement was mediated by gut microbiota changes. Design was non-randomised, open-label, controlled before-and-after. Of 53 participants, 20 with IBS were given B. infantis M-63 (1×109 cfu/sachet/day) for three months and 33 were controls. IBS symptom severity scale, hospital anxiety and depression scale, SF-36 Questionnaire, hydrogen breath testing for small intestinal bacterial overgrowth and stools for 16S rRNA metagenomic analysis were performed before and after intervention. 11 of 20 who were given probiotics (M-63) and 20 of 33 controls completed study as per-protocol. Mental well-being was improved with M-63 vs controls for full analysis (P=0.03) and per-protocol (P=0.01) populations. Within-group differences were observed for anxiety and bodily pain (both P=0.04) in the M-63 per-protocol population. Lower ratio of Firmicutes/Bacteroidetes was observed with M-63 vs controls (P=0.01) and the lower ratio was correlated with higher post-intervention mental score (P=0.04). B. infantis M-63 is probably effective in improving mental health of victims who developed IBS after floods and this is maybe due to restoration of microbial balance and the gut-brain axis. However, our conclusion must be interpreted within the context of limited sample size. The study was retrospectively registered on 12 October 2017 and the Trial Registration Number (TRN) was NCT03318614.