Toward the Drug Factory Microbiome: Microbial Community Variations in Antibiotic-Producing Clean Rooms.

Microbiome projects are currently booming around the globe, enabled by advances in culture-independent microbial community analysis and high-throughput sequencing. One emerging application of microbiome science involves exploring microbial diversity in built environments, and one unexplored built environment is the pharmaceutical factory, notably factories producing antibiotics, as they could be enriched in antibiotic-resistant microbes. To examine the drug factory microbiome, we launched this interdisciplinary hypothesis-generating study to benchmark culture-independent microbiome analysis in drug manufacturing units producing antibiotics and nonantibiotic drugs, against traditional microbial identification and quantification techniques. Over a course of 4 months, we prospectively collected 234 samples from antibiotic (kanamycin and amoxicillin) and nonantibiotic (acetaminophen) production clean rooms within a pharmaceutical factory in Egypt. All samples were analyzed by traditional culture-based methods, and microbial communities of representative samples were profiled by16S rRNA gene sequencing. In addition, antibiotic resistance profiles of some samples were determined, and representative resistance genes were screened. The 16S rRNA analysis revealed a typical predominance of Proteobacteria (36%), Firmicutes (31%), and Bacteroidetes (16%). The microbial composition of the samples was highly affected by the use of water, environmental conditions during the production process, the presence of personnel, and the type of the product. The effect of these factors was confirmed by total aerobic microbial counts and identification of biomarker microbes. In conclusion, these observations can aid in the future for optimal design and management of pharmaceutical manufacturing units, and speak to a greater need for implementing microbiome research in the quality assurance of built environments.

Right ventricular function in patients with beta thalassemia: relation to serum ferritin level.

Cardiac dysfunction is a major cause of death in patients with beta thalassemia. Right ventricular (RV) contribution to cardiac morbidity and mortality in these patients has been suggested. We aimed to assess RV function in beta thalassemia (beta-Th) patients and to detect the relation of serum ferritin level to RV dysfunction. Thirty young patients with beta-Th and 15 age-matched normal subjects (NL) were included. We measured RV end diastolic and end systolic diameters (RVEDD and RVESD), RV % fractional shortening (RVFS), RV pressure (RVP), lateral and septal tricuspid annular systolic and diastolic tissue Doppler velocities (Sa, Ea, Aa & Ea/Aa), and RV myocardial systolic and diastolic velocities at the basal RV segment (RVSm, RVEm, RVAm & RVEm/Am). Serum ferritin level was measured in beta-Th patients who were divided accordingly into two groups; G1 with serum ferritin > or =2,000 microg/L and G2 with serum ferritin < 2,000 microg/L. Compared to NL subjects, beta-Th patients had significantly higher RVEDD, RVESD & RVP, lower RVFS, higher Aa, and lower Ea/Aa at lateral and septal tricuspid annular sites, higher RVAm and lower RVEm/Am. Patients with higher serum ferritin level (G1) had higher RVP, higher RVEDD and RVESD, lower Sa at the lateral annular site and lower RVSm than patients in G2. High serum ferritin level was significantly associated with pulmonary hypertension. We concluded that patients with beta-Th have RV diastolic dysfunction, pulmonary hypertension is common, and the presence of RV systolic dysfunction in these patients is related to the higher level of serum ferritin.

Use of strain and tissue velocity imaging for early detection of regional myocardial dysfunction in patients with beta thalassemia.

BACKGROUND AND AIM OF STUDY: Iron overload contributes to cardiac dysfunction in patients with beta thalassemia (Th). Tissue velocity and strain imaging (TVI and SI) might prove useful in early detection of regional myocardial dysfunction in these patients. The aim of this study is to clarify the value of TVI and SI in early detection of regional myocardial dysfunction in thalassemia patients. METHODS AND RESULTS: This study included two age-matched groups; G1: 27 Th patients and G2: 14 normal subjects. Conventional echo-Doppler measures of LV and RV dimensions and function were obtained. TVI measures included systolic and diastolic myocardial velocities (Sm, Em, Am and Em/Am) of the basal segments of septal wall, lateral LV and RV free walls. Systolic strain values were measured in the same basal segments and included S-septal, S-LV and S-RV. Strain and TVI data were compared in the two groups. Sm and strain values were compared in the different walls (LV, RV and septum) in each group separately. S-LV was lower in G1 than G2 (20.9 +/- 6.8 vs 27.2 +/- 4.3, p < 0.001), while S-septal was higher in G1 than G2 (31.1 +/- 8.3 vs 25.1 +/- 3.8, p < 0.01). TVI measures of diastolic performance of the septal and RV walls were different in G1 compared to G2. Septal-Em was lower, septal-Am was higher and septal-Em/Am was lower in G1 compared to G2. RV-Am was higher and RV-Em/Am was lower in G1 compared to G2. Other SI and TVI measures were not significantly different in G1 from G2. Sm and strain values were lower in the lateral LV wall compared to septal wall in G1 but not in G2, while the corresponding values of the RV wall were higher than those of the septal and LV walls in both groups (G1 and G2). CONCLUSION: Thalassemia patients have regional systolic dysfunction in the lateral LV wall and regional diastolic dysfunction in the septal and RV wall. TVI and the newer modality SI are promising tools for quantitative assessment of regional myocardial function. SI seems more capable of early detection of regional myocardial dysfunction.