Heparin Dosing During Percutaneous Coronary Intervention and Obesity.

ABSTRACT: Unfractionated heparin is the most common anticoagulant used during percutaneous coronary intervention. Practice guidelines recommend an initial weight-based heparin bolus dose between 70 and 100 U/kg to achieve target activated clotting time (ACT) of 250-300 seconds. The impact of severe obesity on weight-based heparin dosing is not well studied. We performed a retrospective analysis of 424 patients undergoing percutaneous coronary intervention who received heparin for anticoagulation. We collected detailed data on cumulative heparin administration and measured ACT values in this cohort. We performed separate analyses to identify clinical predictors that may affect dose-response curves. There was significant variability in dosing with mean dose of 103.9 ± 32-U/kg heparin administered to achieve target ACT ≥ 250 seconds. Women received higher initial heparin doses when adjusted for weight than men (97.6 ± 31 vs. 89 ± 28 U/kg, P = 0.004), and only 49% of patients achieved ACT ≥ 250 s with the initial recommended heparin bolus dose (70-100 U/kg). Lower heparin dose (U/kg) was required in obese patients to achieve target ACT. In multivariate linear regression analysis with ACT as dependent variable, after inclusion of weight-based dosing for heparin, body mass index was the only significant covariate. In conclusion, there is significant variability in the therapeutic effect of heparin, with a lower weight-adjusted heparin dose required in obese patients.

Prevalence, genetic diversity, antibiotic resistance and biofilm formation of Acinetobacter baumannii isolated from urban environments.

AIM: Acinetobacter baumannii is a well-known nosocomial pathogen that has been isolated from different clinical sources. This pathogen also causes community-acquired infections, with mortality rates as high as 64%. The exact natural habitat of this bacterium is still unknown. In this study, we investigated the prevalence of A. baumannii in diverse soil and high-touch surface samples collected from a university campus, malls, parks, hypermarkets and produce markets, roundabout playground slides and bank ATMs. METHODS AND RESULTS: All obtained isolates were characterized for their antibiotic susceptibility, biofilm formation capacities, and were typed by multi-locus sequence analysis. A total of 63 A. baumannii isolates were recovered, along with 46 Acinetobacter pittii and 8 Acinetobacter nosocomialis isolates. Sequence typing revealed that 25 A. baumannii isolates are novel strains. Toilets and sink washing basins were the most contaminated surfaces, accounting for almost 50% of the isolates. A number of A. baumannii (n = 10), A. pittii (n = 19) and A. nosocomialis (n = 5) isolates were recovered from handles of shopping carts and baskets. The majority of isolates were strong biofilm formers and 4 isolates exhibited a multi-drug resistant phenotype. CONCLUSIONS: Our study is the first to highlight community restrooms and shopping carts as potential reservoirs for pathogenic Acinetobacter species. Further studies are required to identify the reasons associated with the occurrence of A. baumannii inside restrooms. Proper disinfection of community environmental surfaces and spreading awareness about the importance of hand hygiene may prevent the dissemination of pathogenic bacteria within the community. SIGNIFICANCE AND IMPACT OF THE STUDY: Serious gaps remain in our knowledge of how A. baumannii spreads to cause disease. This study will advance our understanding of how this pathogen spreads between healthcare and community environments. In addition, our findings will help healthcare decision-makers implement better measures to control and limit further transmission of A. baumannii.

Methicillin-resistant Staphylococcus aureus contamination of high-touched surfaces in a university campus.

AIM: Methicillin-resistant Staphylococcus (MRSA) is a public and occupational health concern, both in community and healthcare settings. In recent years, community-acquired MRSA (CA-MRSA) has emerged as a major causative agent of infections in individuals with no health care exposure or any of the classical risk factors associated with infections. Environmental surfaces frequently touched by hands play a role in the transmission of CA-MRSA, where inanimate objects are considered potential reservoirs and the source of MRSA infections. The purpose of this study was to examine the prevalence of MRSA on environmental surfaces inside a university campus. METHODS AND RESULTS: A total of 1078 high-touch surface samples were collected from door handles, light switches, desks, keyboards and restroom surfaces. MRSA isolates were identified and confirmed by PCR, utilizing the Staph. aureus nuc and mecA genes. Antibiotic resistance profiles were determined using disc diffusion and minimum inhibitory concertation methods. In addition, the ability to form biofilms was investigated by the 96-well plate microdilution technique. PCR assays were performed to detect enterotoxin and antibiotic-resistant genes. The genetic diversity of MRSA was determined through multi-locus sequence typing (MLST), spa and agr typing methods. The overall contamination of Staph. aureus and MRSA was 14.6% (157/1078) and 2.8% (30/1078), respectively. The highest rate of MRSA contamination was detected in restroom sinks and door handles. All MRSA isolates were MDR, with the highest resistance observed was against trimethoprim-sulfamethoxazole. Most MRSA isolates (29/30, 97%) carried at least one gene encoding for staphylococcal enterotoxins (SE), with 10 different SE genotypes were observed. A total of 16 different spa types were detected among the 30 MRSA isolates. Multi-locus sequence typing revealed that 21 MRSA isolates belonged to eight known sequence types (ST), while nine isolates were novel strains. The most detected ST and spa types were ST22 and t223, respectively. Agr types I and III were represented in 28 out of the 30 isolates. The majority of the isolates carried SCCmec type IV, but only one isolate was positive for PVL. CONCLUSIONS: Our findings signify the potential of the high-touch surfaces in harbouring and transmitting MRSA to campus staff and students. Thus, the implementation of effective prevention measures outside the healthcare setting is needed to reduce the risk of acquiring CA-MRSA infections. SIGNIFICANCE AND IMPACT: MRSA infections impose a profound economic burden due to illness and productivity loss. The results of this study not only help us to better understand the environmental reservoirs of this pathogen, but also provide information about its transmission pathways and healthcare settings entry routs.

Virulence, antimicrobial susceptibility and phylogenetic analysis of Cronobacter sakazakii isolates of food origins from Jordan.

AIMS: The aim was to characterize a collection of Cronobacter sakazakii isolates collected from various origins in Jordan. METHODS AND RESULTS: The isolates were characterized using 16S rRNA sequencing, DNA microarray, multi-locus sequence typing (MLST), O-serotyping, virulence gene identification and antibiotic susceptibility testing. The identities and phylogenetic relatedness revealed that C. sakazakii sequence type 4 (ST4) and Csak O:1 serotype were the most prevalent STs and serovars amongst these C. sakazakii strains. PCR screening of putative virulence genes showed that the siderophore-interacting protein gene (sip) and iron acquisition gene clusters (eitCBAD and iucABCD/iutA) were the most detected genes with noticeable variability in the type 6 secretion system (T6SS) and filamentous hemagglutinin/adhesion (FHA) gene loci. The antibiotic resistance profiles revealed that the majority of the isolates were susceptible to all antibiotics used despite harbouring a class C ß-lactamase resistance gene. CONCLUSIONS: The results described in this report provide additional insights about the considerable genotypic and phenotypic heterogeneity within C. sakazakii. SIGNIFICANCE AND IMPACT OF THE STUDY: The information reported in this study might be of great value in understanding the origins of C. sakazakii isolates, in addition to their diversity and variability, which might be helpful in preventing future outbreaks of this pathogen.

Genomic detection of waterborne enteric viruses as water quality indicators in Al-Zarqa River, Jordan.

Al-Zarqa River is the second main tributary to River Jordan after the Yarmouk River. The river flow has been modified by discharge of industrial wastewater and treated domestic water. Concerns about the occurrence of waterborne pathogenic viruses in the surface waters of Al-Zarqa River prompted the analysis of the surface water quality with respect to the presence of enteric viruses. Viruses were concentrated from a total of 33 different water environmental samples including raw sewage, effluent samples and river water collected from and around the river over a period of 11 months. Calculated recovery yields for these concentration methods ranged between 2 and 8%. Polymerase chain reaction (PCR), reverse transcriptase-PCR (RT-PCR), nested RT-PCR and southern blotting hybridization analysis were used for the detection of hepatitis A virus, norovirus, astrovirus and human adenovirus 40/41, with the later one being detected in 21 (64%) of the samples that also showed previous positive presence for enteroviruses. To our knowledge, this is the first molecular biology report in Jordan describing the circulation of adenoviruses, which were detected more frequently than enteroviruses in sewage and water samples, and therefore, they can be used as an index for the presence of human pathogenic viruses in water environment.

Predictors of growth of Escherichia coli on lab coats as part of hospital-acquired infection transmission through healthcare personnel attire.

OBJECTIVES: Previous research has documented the presence of microbes on healthcare personnel (HCP) attire. This study aimed to explore the bacterial contamination and predictors of Escherichia coli (E coli) growth, as well as, hygiene and handling practices of HCP attire that could influence growth of E coli. METHODS: Descriptive, cross-sectional study was used in this study. Convenience sampling of the 188 HCP was recruited from a main comprehensive hospital in the northern part of Jordan. Three swab samples were collected from three different parts of lab coats used by each participant. The generalised mixed linear model was used for the categorical variables and to identify the predictors of E coli growth on HCP attire. RESULTS: Enterococcus faecalis was the most common species of bacteria found on lab coat. The HCP attire coming from the emergency department (ED) was highlighted with slightly higher contamination of E coli compared with other departments, such as critical care units. Factors associated with significant E coli growth on HCP attire were lab coat use over scrubs and borrowing of lab coats. The predictors of positive E coli growth were working in the ED, storing HCP attire in hospital lockers, believing the transmission of pathogens by HCP attire and carrying attire wrapped around arms. IMPLICATIONS: Hygiene practices and policies, including a washing facility on the hospital premises, are a must to keep the lab coats clean. CONCLUSION: HCP should be cautious about the method of use and storage of lab coats they wear.

Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolated from three major hospitals in Jordan.

BACKGROUND: In the last decade, incidences of carbapenem-resistant Acinetobacter baumannii have been increasingly reported worldwide. Consequently, A. baumannii was included in the World Health Organization's new list of critical pathogens, for which new drugs are desperately needed. The objective of this research was to study the molecular epidemiology and antimicrobial susceptibility of clinical carbapenem-resistant A. baumannii isolated from Jordanian hospitals. METHODS: A total of 78 A. baumannii and 8 Acinetobacter spp. isolates were collected from three major hospitals in Jordan during 2018. Disc diffusion and microdilution methods were used to test their susceptibility against 19 antimicrobial agents. Multilocus sequence typing (MLST) was performed using the Pasteur scheme, followed by eBURST analysis for all isolates. PCR was used to detect ß-lactam resistance genes, blaOXA-23-like , blaOXA-51-like , and blaNDM-1 . RESULTS: Of the 86 tested isolates, 78 (90.6%) exhibited resistance to carbapenems, whereas no resistance was recorded to tigecycline or polymyxins. Based on the resistance profiles, 10.4% and 84.8% of isolates were classified into multidrug resistant (MDR) or extensively drug resistant (XDR), respectively. The most prevalent carbapenems resistance genes amongst isolates were blaOXA-51-Like (89.5%), followed by blaOXA-23-Like (88.3%) and blaNDM-1 (10.4%). MLST revealed the presence of 19 sequence types (STs), belonging to eight different international complexes. The most commonly detected clonal complex (CC) was CC2, representing 64% of all typed isolates. CONCLUSIONS: This is the first study to report the clonal diversity of A. baumannii isolates in Jordan. A high incidence of carbapenem resistance was detected in the isolates investigated. In addition, our findings provided evidence for the widespread of blaOXA-23-like harbouring carbapenem-resistant A. baumannii and belonging to CC2. The number of XDR isolates identified in this study is alarming. Thus, periodic surveillance and molecular epidemiological studies of resistance factors are important to improve treatment outcomes and prevent the spread of A. baumannii infections.

Antagonistic effects of Lactobacillus reuteri against Escherichia coli O157:H7 in white-brined cheese under different storage conditions.

This study aimed to investigate the survival of the foodborne pathogen Escherichia coli O157:H7 in white-brined cheeses as influenced by the presence of Lactobacillus reuteri. The white cheeses were made from pasteurized bovine milk inoculated with E. coli O157:H7 (cocktail of 3 strains) to achieve ∼5 log10 cfu/g with absence or presence of Lb. reuteri (∼6 log10 cfu/g). Cheese samples were brined in 10% or 15% NaCl solution and stored at 10°C and 25°C for 28 d. The white-brined cheeses were assessed for salt content, pH, water activity (Aw), and numbers of E. coli O157:H7, Lb. reuteri, nonstarter lactic acid bacteria (NSLAB), yeasts, and molds. Results showed that E. coli O157:H7 survived in cheese stored in both brine solutions at 10°C and 25°C regardless of the presence of Lb. reuteri. A substantial reduction was observed in cheese stored in 10% NaCl brine at 25°C, followed by cheese stored in 15% NaCl brine at 10°C by 2.64 and 2.16 log10 cfu/g, respectively, in the presence of Lb. reuteri and by 1.02 and 1.87 log10 cfu/g, respectively, in the absence of Lb. reuteri under the same conditions. The pathogen in brine solutions survived but at a lower rate. Furthermore, the growth of Lb. reuteri and NSLAB were enhanced or slightly decreased in cheese and brine by 28 d, respectively. The salt concentrations of cheese ranged from 4 to 6% and 5 to 7% (wt/wt), during 28-d ripening in 10 and 15% brine, respectively. Values of pH and Aw slightly increased at d 1 after exposure to brine and reached 4.69 to 6.08 and 0.91 to 0.95, respectively, in all treatments. Therefore, the addition of Lb. reuteri can be used as a biopreservation method to inhibit the survival of E. coli O157:H7 in white-brined cheese when combined with the appropriate temperature, NaCl level, and storage time.

Inactivation of Salmonella spp. in tahini using plant essential oil extracts.

Tahini is a popular food product in the Middle East region and is used as a major ingredient in several ready-to-eat food products. Tahini and its products have been linked to foodborne illness outbreaks and product recalls worldwide as a result of Salmonella spp. contamination. The objectives of the current study were to investigate: i) the effectiveness of 10 plant essential oil extracts on the viability of Salmonella spp. using disc diffusion ii) the antimicrobial activity of the most effective oils against Salmonella spp. in commercial or 10% w/v hydrated tahini (tahini-based product model) stored at 37, 25 and 10 °C for 28 d and iii) the effect of the addition of essential oil extracts on the sensory acceptability of tahini and hydrated tahini. Among the tested essential oils, thyme (TO) and cinnamon oil (CO) showed the highest antimicrobial activity against tested Salmonella spp. at 37 and 10 °C using a disc diffusion assay method. In tahini, the addition of 2.0% CO reduced the numbers of Salmonella spp. by 2.87, 2.64 or 2.35 log10 CFU/ml at 37, 25 or 10 °C, respectively, by 28 d. However, the antimicrobial activity of CO was more pronounced at all storage temperatures in hydrated tahini where no viable cells were detected after 3 d storage at 25 and 37 °C, or after 7 d at 10 °C. However, at 25 and 37 °C, the antimicrobial activity of CO was more evident since no viable cells were detected after 14 d when 0.5% was used. The numbers of Salmonella spp. were reduced by 3.29, 3.03 or 2.17 log10 CFU/ml at 37, 25 or 10 °C, respectively, after 28 d when 2.0% TO was added to tahini. Salmonella spp. were not detected in the hydrated tahini treated with 2.0% TO after 28 d at 37 °C or 25 °C, while at 10 °C, the numbers of Salmonella spp. were not significantly reduced after 28 d in hydrated tahini compared to the initial numbers at zero time. Therefore, the addition of TO and CO could be used to preclude the post process contamination of tahini with foodborne pathogens, yet, the addition of TO and CO to tahini reduced its consumer acceptability compared untreated tahini.

Force degradation of orthodontic latex elastics: An in-vivo study.

INTRODUCTION: Our objectives were to assess the force degradation of orthodontic latex elastics over 48 hours in vivo and to study the relationship between the amount of mouth opening and the degree of force decay. METHODS: Fifty-two orthodontic patients wearing fixed appliances using Class II elastics were asked to wear premeasured-force 3/16-in heavy and medium intermaxillary elastics. The force amounts were measured and compared at different time intervals. RESULTS: Fifty percent of the force was lost after 3.9 hours for the medium elastics and after 4.9 hours for the heavy elastics. A continuous significant force drop in all elastics was seen at all time intervals (P <0.05, P <0.001). There was greater force loss in the heavy elastics compared with the medium elastics in vivo at all time intervals (P <0.001); the rates of force loss, however, were similar. CONCLUSIONS: Fifty percent of force degradation occurred in the first 4 to 5 hours. Because of breakage and for oral hygiene purposes, orthodontic elastics should be changed daily; otherwise, elastics can be used for 48 hours. Force decay of the elastics was correlated to the lateral distance between the maxillary canine and the mandibular first molar in occlusion.

Behavior of Escherichia coli O157:H7 and Listeria monocytogenes during fermentation and storage of camel yogurt.

In addition to its nutritional and therapeutic properties, camel milk has the ability to suppress the growth of a wide range of foodborne pathogens, but there is a lack of information regarding the behavior of these pathogens in products such as yogurt produced from camel milk. The objective of the current study was to investigate the behavior of Listeria monocytogenes and Escherichia coli O157:H7 during manufacture and storage of camel yogurt. Camel milk inoculated with L. monocytogenes and E. coli O157:H7 was fermented at 43° C for 5h using freeze-dried lactic acid bacteria (LAB) starter cultures (Streptococcus thermophilus and Lactobacillus bulgaricus) and stored at 4 or 10 °C for 14 d. Camel milk inoculated with L. monocytogenes and E. coli O157:H7 without starter culture was also prepared. During fermentation, the numbers of L. monocytogenes and E. coli O157:H7 increased 0.3 and 1.6 log cfu/mL, respectively, in the presence of LAB, and by 0.3 and 2.7 log cfu/mL in the absence of LAB. During storage at 4 or 10 °C, L. monocytogenes increased 0.8 to 1.2 log cfu/mL by 14 d in camel milk without LAB, but in the presence of LAB, the numbers of L. monocytogenes were reduced by 1.2 to 1.7 log cfu/mL by 14 d. Further, E. coli O157:H7 numbers in camel milk were reduced by 3.4 to 3.5 log cfu/mL in the absence of LAB, but E. coli O157:H7 was not detected (6.3 log cfu/mL reduction) by 7d in camel yogurt made with LAB and stored at either temperature. Although camel milk contains high concentrations of natural antimicrobials, L. monocytogenes was able to tolerate these compounds in camel yogurt stored at refrigerator temperatures. Therefore, appropriate care should be taken during production of yogurt from camel milk to minimize the potential for postprocess contamination by this and other foodborne pathogens.

Effects of osmotic pressure, acid, or cold stresses on antibiotic susceptibility of Listeria monocytogenes.

Prevalence of antibiotic resistance of Listeria monocytogenes isolated from a variety of foods has increased in many countries. L. monocytogenes has many physiological adaptations that enable survival under a wide range of environmental stresses. The objective of this study was to evaluate effects of osmotic (2, 4, 6, 12% NaC), pH (6, 5.5, 5.0) and cold (4 °C) stresses on susceptibility of three isolates of L. monocytogenes towards different antibiotics. The minimal inhibitory concentrations (MICs) of tested antibiotics against unstressed (control), stressed or post-stressed L. monocytogenes isolates (an ATCC strain and a meat and dairy isolate) were determined using the broth microdilution method. Unstressed cells of L. monocytogenes were sensitive to all tested antibiotics. In general, when L. monocytogenes cells were exposed to salt, cold and pH stresses, their antibiotic resistance increased as salt concentration increased to 6 or 12%, as pH was reduced to pH 5 or as temperature was decreased to 10 °C. Results showed that both meat and dairy isolates were more resistant than the ATCC reference strain. Use of sub-lethal stresses in food preservation systems may stimulate antibiotic resistance responses in L. monocytogenes strains.

Treatment of radial artery occlusions using balloon angioplasty and localized intra-arterial abciximab.

OBJECTIVES: To study an alternative strategy for the treatment of radial artery occlusion (RAO) using balloon angioplasty and intrathrombus administration of abciximab. BACKGROUND: RAO is a well-described complication of transradial procedures. The optimal method to restore the patency of the radial artery following its occlusion remains unclear. Spontaneous recanalization can occur in some patients and systemic anticoagulation can be recommended but is often unsuccessful. METHODS: A retrospective review of all patients in our database from 2009 to 2013 with RAO who underwent treatment with balloon angioplasty and intra-arterial abciximab administered directly at the site of occlusion. RESULTS: Four patients with symptomatic RAO following transradial catheterization were treated with balloon angioplasty and a 90-second intrathrombus infusion of abciximab. All procedures were successful and patency was documented the following day with duplex sonography and again at follow-up (mean 189 days). The patients also remained free of symptoms at follow-up. The fifth patient was treated with balloon angioplasty alone. This patient suffered symptomatic reocclusion of the radial artery. CONCLUSIONS: Balloon angioplasty and intrathrombus administration of abciximab via a catheter appears to be a safe, effective, and durable technique for reestablishing the patency of an occluded radial artery following transradial catheterization. Larger studies are needed to confirm our findings and establish the role for this technique in an algorithm for treatment of RAO.

Use of acetic and citric acids to control Salmonella Typhimurium in tahini (sesame paste).

Since tahini and its products have been linked to Salmonella illness outbreaks and product recalls in recent years, this study assessed the ability of Salmonella Typhimurium to survive or grow in commercial tahini and when hydrated (10% w/v in water), treated with 0.1%-0.5% acetic or citric acids, and stored at 37, 21 and 10 °C for 28 d. S. Typhimurium survived in commercial tahini up to 28 d but was reduced in numbers from 1.7 to 3.3 log10 CFU/ml. However, in the moist or hydrated tahini, significant growth of S. Typhimurium occurred at the tested temperatures. Acetic and citric acids at ≤0.5% reduced S. Typhimurium by 2.7-4.8 log10 CFU/ml and 2.5-3.8 log10 CFU/ml, respectively, in commercial tahini at 28 d. In hydrated tahini the organic acids were more effective. S. Typhimurium cells were not detected in the presence of 0.5% acetic acid after 7 d or with 0.5% citric acid after 21 d at the tested temperatures. The ability of S. Typhimurium to grow or survive in commercial tahini and products containing hydrated tahini may contribute to salmonellosis outbreaks; however, use of acetic and citric acids in ready-to-eat foods prepared from tahini can significantly minimize the risk associated with this pathogen.

In vitro evaluation of potential complexation between bovine insulin and bovine serum albumin.

The objective of this study was to examine the possible binding of bovine insulin (BI) with bovine serum albumin (BSA) to form a new potential diabetogenic irreversible complex protein. Several preparations of BSA and BI were prepared. Both capillary electrophoresis and spectrophotometric analysis were undertaken to test the possibility of complexation between BI and BSA. HPLC was used to test whether the potential complex of BI and BSA is reversible or irreversible. The optimum deviation between the real and calculated absorbances was observed at a BI/BSA ratio of 2. Moreover, the migration time of BI decreased substantially with increasing ratio of BI to BSA until it became almost constant at equal molar ratio of BI/BSA. While the majority of the 2:1 BI-BSA sample detached during the HPLC analysis, which confirms the reversible character of BI-BSA binding, the HPLC chromatogram also emphasizes the formation of an irreversible complexation between the two proteins. This study provides evidence of the formation of reversible and irreversible new BI-BSA complexes under physiological conditions. This highlights the importance of examining the possible diabetogenicity of BI-BSA complex in genetically susceptible people.

Anti-bacterial, anti-biofilm and anti-quorum sensing activities of honey: A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Man has used honey to treat diseases since ancient times, perhaps even before the history of medicine itself. Several civilizations have utilized natural honey as a functional and therapeutic food to ward off infections. Recently, researchers worldwide have been focusing on the antibacterial effects of natural honey against antibiotic-resistant bacteria. AIM OF THE STUDY: This review aims to summarize research on the use of honey properties and constituents with their anti-bacterial, anti-biofilm, and anti-quorum sensing mechanisms of action. Further, honey's bacterial products, including probiotic organisms and antibacterial agents which are produced to curb the growth of other competitor microorganisms is addressed. MATERIALS AND METHODS: In this review, we have provided a comprehensive overview of the antibacterial, anti-biofilm, and anti-quorum sensing activities of honey and their mechanisms of action. Furthermore, the review addressed the effects of antibacterial agents of honey from bacterial origin. Relevant information on the antibacterial activity of honey was obtained from scientific online databases such as Web of Science, Google Scholar, ScienceDirect, and PubMed. RESULTS: Honey's antibacterial, anti-biofilm, and anti-quorum sensing activities are mostly attributed to four key components: hydrogen peroxide, methylglyoxal, bee defensin-1, and phenolic compounds. The performance of bacteria can be altered by honey components, which impact their cell cycle and cell morphology. To the best of our knowledge, this is the first review that specifically summarizes every phenolic compound identified in honey along with their potential antibacterial mechanisms of action. Furthermore, certain strains of beneficial lactic acid bacteria such as Bifidobacterium, Fructobacillus, and Lactobacillaceae, as well as Bacillus species can survive and even grow in honey, making it a potential delivery system for these agents. CONCLUSION: Honey could be regarded as one of the best complementary and alternative medicines. The data presented in this review will enhance our knowledge of some of honey's therapeutic properties as well as its antibacterial activities.

Dual Coronary-Pulmonary Artery Fistula in a Patient with Severe Bicuspid Aortic Valve Stenosis.

A 62-year-old male presented to the emergency department with acute viral bronchitis and worsening of his chronic dyspnea on exertion. Incidentally, a murmur was detected on physical examination. Extensive work-up, including coronary computed tomography angiography, revealed a rare combination and potential association between severe bicuspid aortic valve stenosis and coronary-pulmonary artery fistulas.

Extensively drug-resistant Acinetobacter baumannii: role of conjugative plasmids in transferring resistance.

Acinetobacter baumannii is one of the most successful pathogens that can cause difficult-to-treat nosocomial infections. Outbreaks and infections caused by multi-drug resistant A. baumannii are prevalent worldwide, with only a few antibiotics are currently available for treatments. Plasmids represent an ideal vehicle for acquiring and transferring resistance genes in A. baumannii. Five extensively drug-resistant A. baumannii clinical isolates from three major Jordanian hospitals were fully sequenced. Whole-Genome Sequences (WGS) were used to study the antimicrobial resistance and virulence genes, sequence types, and phylogenetic relationship of the isolates. Plasmids were characterized In-silico, followed by conjugation, and plasmid curing experiments. Eight plasmids were recovered; resistance plasmids carrying either aminoglycosides or sulfonamide genes were detected. Chromosomal resistance genes included blaOXA-66, blaOXA-91, and blaOXA-23, and the detected virulence factors were involved in biofilm formation, adhesion, and many other mechanisms. Conjugation and plasmid curing experiments resulted in the transfer or loss of several resistance phenotypes. Plasmid profiling along with phylogenetic analyses revealed high similarities between two A. baumannii isolates recovered from two different intensive care units (ICU). The high similarities between the isolates of the study, especially the two ICU isolates, suggest that there is a common A. baumannii strain prevailing in different ICU wards in Jordanian hospitals. Three resistance genes were plasmid-borne, and the transfer of the resistance phenotype emphasizes the role and importance of conjugative plasmids in spreading resistance among A. baumannii clinical strains.

Effects of embryonic thermal manipulation on the immune response to post-hatch Escherichia coli challenge in broiler chicken.

Background and Aim: Thermal manipulation (TM), exposure to mild heat shock during embryogenesis, which is a critical developmental period of broiler chickens, improves tissue stability, oxidative stress response, and immune response during heat stress. Thermal manipulation could be more cost-effective than other methods to boost the immune response. This study aimed to evaluate the impact of TM during embryogenesis, concomitant with an Escherichia coli challenge, on body weight (BW), body temperature (Tb), and splenic mRNA expression of cytokines (Interleukin [IL]-1ß, IL-2, IL-6, IL-8, IL-12, IL-15, IL-16, IL-18, and interferon [IFN]-γ) in poultry. Materials and Methods: A total of 740 fertile eggs were procured from a certified Ross broiler breeder. The eggs were divided into two incubation groups: the control and TM groups. The eggs in the control group were kept at 37.8°C air temperature and 56% relative humidity (RH) during incubation; eggs of the TM group were incubated under standard conditions, except for embryonic days 10-18, during which they were incubated at 39°C and 65% RH for 18 h daily. On the 7th day of incubation, eggs with dead embryos were excluded. After hatching was complete, each group was further subdivided into saline-treated or E. coli-challenged groups. The E. coli (serotype 078 with the dose of 1.5 × 105 colony-forming unit/mL) challenge was performed when the birds were 20 days old. Body weight and Tb measurements were taken on post-hatch days 20, 21, 23, and 25. Splenic mRNA expression of cytokines (IL-1ß, IL-2, IL-6, IL-8, IL-12, IL-15, IL-16, IL-18, and IFN-γ) was analyzed by real-time quantitative polymerase chain reaction. Results: Following the E. coli challenge, the TM-treated group's body performance parameters (BW and Tb) were significantly increased compared with the control group. Body weight was higher in the TM group than in the control group (p < 0.05); Tb was lower in the TM group than in the control group (p < 0.05). The mRNA levels of IL and IFN-γ were more stable and moderately induced in the TM group compared with the control group. Thermal manipulation altered the basal mRNA levels of ILs and IFN-γ and changed their expression dynamics after the E. coli challenge. Conclusion: Thermal manipulation during embryogenesis could boost the immune system response to E. coli.

Isolation of extensively drug resistant Acinetobacter baumannii from environmental surfaces inside intensive care units.

BACKGROUND: Acinetobacter baumannii is a nosocomial pathogen that has emerged as a major threat in the health-care settings, particularly intensive care units (ICUs). The aim of this study was to investigate the prevalence of A. baumannii in the environment of intensive care and emergency units in 4 hospitals in Jordan. METHODS: A total of 311 surface and 26 air samples were collected from 6 different ICUs and 2 emergency units. Examined high-touch surfaces included bed rails, sinks, food tables, trolley handles, ventilator inlets, blankets, sheets, door handles, light switches, bedside tables and drawers, curtains, normal saline stands and neonatal incubators. A. baumannii isolates were identified by CHROMagar and confirmed using 2 different PCR assays. All obtained isolates were characterized for their antibiotic resistance phenotypes, biofilm formation capacities and were typed by multi-locus sequence typing. RESULTS: Of the 337 samples, 24 A. baumannii isolates were recovered, mostly from surfaces in the internal medicine ICUs. Among the 24 isolates, 10 isolates were classified as extensively-resistant (XDR), harbored the blaOXA-23 like gene and able to form biofilms with varying capacities. ST2 was the most frequent sequence type, with all ST2 isolates classified as XDRs. CONCLUSIONS: Our results showed that high-touch surfaces of adult and pediatric ICUs were contaminated with XDR A. baumannii isolates. Therefore, the cleaning practices of the surfaces and equipment surrounding ICU patients should be optimized, and health-care workers should continuously wash their hands and change their gloves constantly to control the spread of this pathogen.