Insufficient decontamination in Sewage treatment plants induce the risk of artificial selection of extended-spectrum ß-lactamase producing Escherichia coli.

Quantitative data about extended-spectrum beta-lactamase producing E. coli (ESBLEC) in the wastewaters are scarce, especially in developing countries. These data could be useful to raise awareness about the potential risk of spreading ESBLEC strains in the community. Water samples were collected weekly over a 10-week period, from one urban sewage treatment plant (STP), one rural STP and one hospital complex's wastewater (HWW) in Turkey. Mean E. coli and ESBLEC loads were determined for each sampling point. For the 580 ESBLEC isolated, antimicrobial resistance profiles, phylogenetic grouping, presence of common beta-lactamese-typesand integrons were studied using PCR. The mean ESBLEC ratio was accounted for 0.58%, 0,12%, 1.53% of the total E. coli in urban, rural untreated wastewater and HWW, respectively. These values were higher for the outlets. The mean number of different antimicrobial classes to which the strains were resistant was highest in urban STP (4.0± 1.6). The antimicrobial resistance ratios of ESBLEC strains isolated from HWW were observed to be in between those of urban and rural STPs. The most common phylogenetic group was C composing (29.7%) and the most susceptible strains belonged to phylogroup B1. Wastewater treatments without sufficient decontamination, resulting in artificial selection of ESBLEC might lead to public health risk as these strains reach communities through environment. To avoid such risks and protect the human health as well as the environment, well-established decontamination measures imposing barriers against this artificial selection should be implemented.

Investigation of VEGF and IL-8 Gene Polymorphisms in Patients with Differentiated Thyroid Cancer.

BACKGROUND: Differentiated thyroid carcinomas (DTC) account for most of the thyroid cancers. The emergence of DTC may be affected by various predisposing genetic alterations and environmental factors The aim of this study was to investigate the role of VEGF C936T and IL-8 A251T gene polymorphisms in the pathogenesis and metastasis of differentiated thyroid cancer. METHODS: The study consisted of 101 patients DTC patients and 109 healthy controls. The parameters of the stage of cancer of the DTC patients at the time of diagnosis (TNM) were recorded. DNA was isolated from blood using a DNA isolation kit. VEGF C936T and IL-8 A251T gene polymorphisms were determined using the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. Distributions of gene polymorphisms were evaluated according to the Hardy-Weinberg principle. RESULTS: The TT genotype from the VEGF C936T genotype distributions was higher in the control group than in the DTC group (p < 0.05). In contrast, the IL-8 A-251T genotype distributions were similar in both groups. No relationship was found between either cytokine gene polymorphism or the DTC stages. The frequency of IL-8 TT was higher in the DTC group with lymph gland metastasis (TT 92%) than in the group without lymph gland metastasis (TT 45.9%) (p < 0.05). CONCLUSIONS: We consider that the VEGF 936 TT genotype may play a protective role in the development of DTC and that the IL-8 A-251 TT genotype may contribute to the DTC lymph node metastasis. Therefore, these genotypes may hold a key to the evaluation of thyroid nodules and the metastasis of DTC.

Antibiotic resistant Staphylococcus aureus in hospital wastewaters and sewage treatment plants with special reference to methicillin-resistant Staphylococcus aureus (MRSA).

AIMS: To investigate the presence of methicillin-resistant Staphylococcus aureus (MRSA) in untreated hospital wastewaters (UHWW), their transmission into the receiving sewage treatment plant (STP) and survival through the STP treatment. METHODS AND RESULTS: Over eight consecutive weeks of sampling, we isolated 224 Staph. aureus strains from UHWW-1, UHWW-2 and its receiving STP inlet (SI) and post-treatment outlet (SO). These strains were typed using the PhP typing method and RAPD-PCR and tested for their antibiotic resistance patterns. Resistance to cefoxitin and the presence of mecA gene identified MRSA isolates. In all, 11 common (C) and 156 single (S) PhP-RAPD types were found among isolates, with two multidrug resistant (MDR) C-types found in H2, SI and SO. These C-type strains also showed resistance to cefoxitin and vancomycin. The mean number of antibiotics to which the strains from UHWW were resistant (5.14 ± 2) was significantly higher than the STP isolates (2.9 ± 1.9) (P < 0.0001). Among the 131 (68%) MRSA strains, 24 were also vancomycin resistant. MDR strains (including MRSA) were more prevalent in hospital wastewaters than in the STP. CONCLUSION: This study provides evidence of the survival of MRSA strains in UHWWs and their transit to the STP and then through to the final treated effluent and chlorination stage. SIGNIFICANCE AND IMPACT OF THE STUDY: This preliminary study identifies the need to further investigate the load of MRSA in hospitals' wastewaters and possible their survival in STPs. From a public health point of view, this potential route of hospital MRSA dissemination is of great importance.

Prevalence and pathogenesis of extended-spectrum beta-lactamase producing Escherichia coli causing urinary tract infection in hospitalized patients.

A total of 296 E. coli strains isolated from hospitalized patients with urinary tract infection were included in this study. These strains were tested for their resistance to 22 antimicrobial drugs and the presence of ESBLs genes coding for TEM, SHV, OXA, and CTX-M. We further characterized them for their interaction with a renal cell line (A-498) and a gastrointestinal cell line (Caco-2). Strains were also typed using a combination of RAPD-PCR, PhP-typing and phylogenetic grouping. Only eight strains (2.7 %) were confirmed as ESBLs producers. The most common clonal type contained 35 isolates and only two of them were ESBLs producers and both showed a high degree of adhesion to both cell lines but only one was able to translocate in Caco-2 cells. These strains belonged to phylogenetic group B2, were resistant to nine antibiotics and carried CTX-M-type of ESBL. The remaining six strains belonged to single clones with different phylogenetic groups and ESBL genotypes and were resistant to between 12 and 15 antibiotics. They also showed a high rate of adhesion to A-498 cells (19 ± 2 to 35 ± 3 CFU/cell) and all translocated in this cell line. The rate of adhesion of ESBL-producing strains to Caco-2 cells (11 ± 3.4 CFU/cell) was significantly lower than A-498 cells (26 ± 8 CFU/cell) (p = 0.0002) and only four of them translocated in Caco-2 cells. Our results suggest that the ESBL-producing clones of E. coli have a potential to translocate and cause septicemia in hospitalized patients with UTI.

Evaluation of cognitive deficits in patients infected with COVID-19.

OBJECTIVE: COVID-19 infection can cause impairments in many cognitive areas. The aim of the present study was to evaluate the cognitive functions of patients who had been infected with COVID-19. PATIENTS AND METHODS: The demographic and infection-related characteristics of patients who had been infected with COVID-19 were determined. Their cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) findings were recorded. The Mini-Mental State Evaluation (MMSE), clock drawing test, forward and backward digit span tests, visual memory test, and Frontal Assessment Battery were applied to the patients. Finger agnosia and ideomotor apraxia were also determined. RESULTS: The study included 176 patients [100 female (56.8%), 76 male (43.2%), mean age 66.09±13.96 years]. About half of the patients were hospitalized for symptoms of COVID-19 infection (n=82, 46.6%). One third of these patients required intensive care (n=26, 14.8%). While 50 (45.9%) of the 109 patients diagnosed with dementia before infection were hospitalized, 32 (47.8%) of the 67 patients without a diagnosis of dementia required hospitalization (p=0.46). The most common neurological finding during COVID-19 infection was insomnia (n=36, 20.5%). The MMSE and visual memory test scores of the patients who were hospitalized for severe respiratory distress were lower than those whose treatment at home was completed (respectively 17.92±7.69/20.59±7.01, p=0.02; 2.53 ±1.73/3.69±2.80, p=0.01). The patients with moderate to severe cognitive impairment had significantly higher CRP levels at admission than the others (37.52±43.09/20.93±31.74, p=0.01, respectively). CONCLUSIONS: Cognitive damage in COVID-19 infection may be caused by ACE receptor density in the pial, hippocampal, and amygdala areas. In addition, the reason why people with severe dementia have a milder infection might be explained by the atrophy in these areas.

Prevalence and persistence of Escherichia coli strains with uropathogenic virulence characteristics in sewage treatment plants.

We investigated the prevalence and persistence of Escherichia coli strains in four sewage treatment plants (STPs) in a subtropical region of Queensland, Australia. In all, 264 E. coli strains were typed using a high-resolution biochemical fingerprinting method and grouped into either a single or a common biochemical phenotype (S-BPT and C-BPT, respectively). These strains were also tested for their phylogenetic groups and 12 virulence genes associated with intestinal and extraintestinal E. coli strains. Comparison of BPTs at various treatment stages indicated that certain BPTs were found in two or all treatment stages. These BPTs constituted the highest proportion of E. coli strains in each STP and belonged mainly to phylogenetic group B2 and, to a lesser extent, group D. No virulence genes associated with intestinal E. coli were found among the strains, but 157 (59.5%) strains belonging to 14 C-BPTs carried one or more virulence genes associated with uropathogenic strains. Of these, 120 (76.4%) strains belonged to seven persistent C-BPTs and were found in all four STPs. Our results indicate that certain clonal groups of E. coli with virulence characteristics of uropathogenic strains can survive the treatment processes of STPs. These strains were common to all STPs and constituted the highest proportion of the strains in different treatment tanks of each STP.

Royal jelly increased map-2 expression in hippocampal neurons of hypothyroid rats: an immunohistochemical study.

We investigated microtubule-associated protein 2 (MAP-2) immunoreactivity of hippocampal neurons and the potential role of royal jelly (RJ) in regulating MAP-2 during experimental hypothyroidism (HT). Thirty adult female Wistar albino rats were randomized into five groups: the control group was untreated, the sham control group was treated with 10 mg/kg 0.9% sterile saline injected intraperitoneally (i.p.), The RJ group was treated with 100 mg/kg RJ by oral gavage, the HT group was treated with 10 mg/kg propylthiouracil (PTU) i.p. to induce experimental hypothyroidism, and the HT + RJ group was treated with 10 mg/kg PTU i.p. + 100 mg/kg RJ by oral gavage. Oral and i.p. administrations were performed once daily for 20 days. Thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels in the serum were measured biochemically, MAP-2 was measured immunohistochemically in the hippocampus and an immunohistochemical H score was calculated. MAP-2 immunoreactivity appeared in the cytoplasm of neuron cell bodies and dendrites in the hippocampal CA3 and CA1 regions in the control, sham control and RJ groups. MAP-2 immunoreactivity decreased significiantly in the HT group compared to control, sham control and RJ groups. Also, vascular dilation and swollen cells were observed following PTU administration. The degeneration that was observed in the HT group decreased by RJ administration. By contrast, MAP-2 immunoreactivity increased following administration of RJ. Experimental hypothyroidism reduced significiantly MAP-2 immunoreactivity in both the CA3 and CA1 regions and caused degeneration, including edema and vascular dilation, in the hippocampus. RJ increased MAP-2 expression and exhibited a therapeutic effect on the degenerative changes.

An underrated potential risk of bronchiectasis: lymph node metastasis of a pulmonary tumorlet.

Pulmonary tumorlets occur as the result of extensive scar caused by bronchiectasis or other inflammatory processes. They are minute lesions found in close association with the bronchioles and may rarely metastasize to lymph nodes. We present a 35-year-old male patient who underwent bilobectomy inferior with a diagnosis of bronchiectasis of 20 years duration. Histologic examination showed cystic bronchiectasis with areas of multiple neuro-endocrine tumorlets in addition to metastatic peribronchial lymph nodes. We emphasize the significance of early surgical treatment of bronchiectasis showing little to no response to medical therapy as well as peribronchial lymph node dissection.

An Underrated Potential Risk of Bronchiectasis: Lymph Node Metastasis of a Pulmonary Tumorlet.

Pulmonary tumorlets occur as the result of extensive scar caused by bronchiectasis or other inflammatory processes. They are minute lesions found in close association with the bronchioles and may rarely metastasize to lymph nodes. We present a 35-year-old male patient who underwent bilobectomy inferior with a diagnosis of bronchiectasis of 20 years duration. Histologic examination showed cystic bronchiectasis with areas of multiple neuro-endocrine tumor-lets in addition to metastatic peribronchial lymph nodes. We emphasize the significance of early surgical treatment of bronchiectasis showing little to no response to medical therapy as well as peribronchial lymph node dissection.

Removal of cadmium from aqueous solution by Nordmann fir (Abies nordmanniana (Stev.) Spach. Subsp. nordmanniana) leaves.

The utility of Nordmann fir (Abies nordmanniana (Stev.) Spach. Subsp. nordmanniana) leaves from Eastern Black Sea region for the removal (sorption) of metal ions from aqueous solutions was investigated. For this, the optimum values of pH, time, metal concentration, leaf concentration, leaf particle size and adsorption capacity were determined. Also the recovery conditions of the metals from leaves were studied. Cd metal was selected because of its toxic properties. Freundlich isotherm model was used to describe the adsorption behaviour and the experimental results obtained for Cd(2+) adsorption, followed this model well. The utility of Nordmann fir leaves to remove toxic metals from aqueous solutions was proved. Hence, this study showed that the leaves of Nordmann fir can provide cheap source as biosorbents for toxic metal removal from natural or wastewaters.

Analysis of mosses along Sarp-Samsun highway in Turkey.

The elemental analysis of mosses along Sarp-Samsun highway in Turkey was determined using energy dispersive X-ray fluorescence method. A radioisotope excited X-ray fluorescence analysis using the method of multiple standard additions is applied for the elemental analysis of mosses. An annular 50 mCi (241)Am radioactive source and annular 50 mCi (55)Fe radioactive source were used for excitation of characteristic K X-rays. An Si(Li) detector which has a 147 eV full width at half maximum for 5.9 keV photons was used for intensity measurements. A qualitative analysis of spectral peaks showed that the samples contained phosphates, potassium, calcium, titanium, iron, strontium, tin and barium. Since this study is the elemental analysis along the highway, one can expect to detect Pb. Due to the detection limit of EDXRF, elements were analyzed with Atomic Absorption Spectroscopy (AAS) for Pb. Evaluation of these elements with their potential hazards for ecology and human is briefly discussed.

The effect of vitamin D levels on pain in carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) and vitamin D deficiency are two discrete common clinical pictures that can cause chronic pain. In this study, we aimed to evaluate the association of 25 (OH) D deficiency with electrophysiological findings and severity of pain in patients with mild CTS. METHOD: The consecutive patients admitted to our laboratory with the symptoms of CTS between May 2016 and August 2016 were enrolled in this study. According to their electrophysiological examination results, only the patients with normal conduction results and ones with mild grade CTS were included. Demographic data, the results of the electrophysiological studies, vitamin D levels (our laboratory normal is>20ng/mL), duration of pain and pain intensity due to CTS, which was assessed with visual analog scale, were collected. RESULTS: Totally, 76 patients (36 patients with mild CTS and 40 without CTS) were included. In the mild CTS patients, vitamin D levels were significantly lower than those electrophysiologically normal patients (P=0.003). The relationship between gender, duration of pain and vitamin D levels were evaluated in the normal and mild CTS group. There was no significant relationship between the pain and vitamin D levels in the normal group, while vitamin D level was significantly lower in the mild CTS group (P=0.730 and P=0.002; respectively). DISCUSSION: Vitamin D deficiency increases the pain intensity in patients with CTS. Treatment of vitamin D deficiency in these patients may play a role in pain relief. Further studies involving analyses of post-vitamin D replacement therapy are warranted to confirm the association between vitamin D deficiency and pain due to CTS.

Hypokalemic paralysis due to thyrotoxicosis accompanied by Gitelman's syndrome.

A 35-year-old male patient was admitted with fatigue and muscle weakness. He had been on methimazole due to thyrotoxicosis for 2 weeks. Laboratory tests showed overt hyperthyroidism and hypokalemia. Potassium replacement was started with an initial diagnosis of thyrotoxic hypokalemic periodic paralysis. Later on, despite the euthyroid condition and potassium chloride treatment, hypokalemia persisted. Further investigations revealed hyperreninemic hyperaldosteronism. The patient was considered to have Gitelman's syndrome (GS) and all genetic analysis was done. A c. 1145C>T, p. Thr382Met homozygote missense mutation located on solute carrier family 12, member gene 3, exon 9 was detected and GS was confirmed.

Association of calcium antagonist use with lower hemoglobin levels in hemodialysis patients.

AIM: Objective of the present study was to investigate whether calcium antagonist use is associated with lower hemoglobin levels and/or higher erythropoiesis stimulating agent (ESA) requirement in hemodialysis patients. METHODS: A total of 130 adult hemodialysis patients were classified into two groups based on calcium antagonist usage for a period of at least 3 months as calcium antagonist users and calcium antagonist non-users. The two groups were compared cross-sectionally in a retrospective manner in terms of demographics, chronic kidney disease aetiologies, Charlson's Comorbidty Index, blood pressure, type of dialysis access, interdialytic body weight gain, cardiothoracic index, complete blood count, biochemistry, regular medication use and consumption of ESA. All independent variables that were different between the groups were subjected to logistic regression analysis. Linear regression analysis with dependent variable of hemoglobin value was also performed RESULTS: ESA consumption and blood pressure were higher, diabetic nephropathy, doxazosin and ACE inhibitor use were more frequent, and hemoglobin was lower in the calcium antagonist users. After logistic regression analysis, diabetic nephropathy, doxazosin use, ACE inhibitor use and lower hemoglobin were associated with calcium antagonist use. After lineer regression analysis, Age, BMI, gender, predialysis creatinine value, dialysis duration, systolic and diastolic blood pressure, doxazosin use, diabetes mellitus and diabetic nephropathy were not related with hemoglobin value. But, higher amount of ESA consumption, ACE inhibitor use and calcium antagonist use were significantly associated with lower hemoglobin value. CONCLUSION: CA use was associated with lower hemoglobin levels in our hemodialysis patient population.

Plasma viscosity as an early cardiovascular risk factor in hirsute women with eumenorrhea or oligomenorrhea.

To investigate plasma viscosity, a hemorheologic variable, in oligomenorrheic and eumenorrheic hirsute women.Descriptive study. Endocrinology and metabolism clinic. Twenty five hirsute women with oligomenorrhea and eumenorrhea and 30 age- and weight-matched healthy, eumenorrheic, nonhirsute women. Plasma viscosity. Plasma viscosity was significantly elevated in hirsute women compared with eumenorrheic nonhirsute women. Significant correlations were observed between plasma viscosity and fasting insulin level, cholesterol level, and diastolic blood pressure. Hirsute women with oligomenorrhea or eumenorrhea had a significantly elevated plasma viscosity compared with healthy controls.

The association of carotid cavernous fistula with Graves' ophthalmopathy.

Graves' ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature.

Comparison of hormonal and metabolic effects of salbutamol infusion in normal subjects and insulin-requiring diabetics.

A comparison of the metabolic effects of salbutamol in diabetic patients and normal subjects showed that salbutamol infused at 5 and 2 microgram/min (a) stimulated hepatic glucose production to a greater extent in diabetic patients than in normal subjects despite prior restoration of the diabetic patients' fasting blood glucose to normal by an overnight infusion of insulin; (b) caused a greater rise in plasma glucose, free fatty acids, glycerol, and ketone-body concentrations in the diabetic patients; and (c) produced a marked fall in plasma-potassium concentrations. The differences between the diabetic and normal groups were accounted for by an immediate (six-fold) stimulation of insulin secretion in the normal subjects.