Antibiotics have been used for decades against Cutibacterium acnes (previously known as Propionibacterium acnes; C. acnes). Alarmingly, antibiotic resistance to this bacterium has become a worldwide ...problem in recent years. No studies are available on the antibiotic susceptibility patterns of C. acnes among Jordanian acne patients and how that is influenced by antibiotic use. This study aims to assess antibiotic resistance patterns of C. acnes clinical isolates and neighboring Gram-positive normal flora of the skin obtained from acne patients attending dermatology clinics in Amman -Jordan appraising the role of antibiotic consumption.
This is a cross-sectional study of acne patients presenting to selected dermatology outpatient clinics over a 6-month study period. Swabs obtained from inflamed lesions were cultured aerobically and anaerobically. Isolates were identified and screened for antibiotic susceptibility. In addition, all patients were asked to fill in a questionnaire that included questions about the history of antibiotic treatment.
C. acnes was isolated from lesions of 100 patients out of 115 participants included in this study. 73% of the isolates were resistant to erythromycin and 59% to clindamycin 37% to doxycycline, 36% to tetracycline, 31% to trimethoprim / sulfamethoxazole, 15% to levofloxacin, and 3% to minocycline. Multi drug resistance (MDR) in C. acnes isolates as well as Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis) with a similar pattern of resistance were detected from the same patient in most cases. A pattern of higher resistance towards variable antibiotic was observed in patients previously treated with antibiotics for acne management.
The findings of this study demonstrate the distribution of antibiotic resistance of C. acnes towards used antibiotics and emphasizes the influence of antibiotic consumption on development of antibiotic resistance. The similar pattern of resistance between skin bacteria tested in this study highlights the genetic transfer of resistance between skin commensals including S. aureus and S. epidermidis hence promoting its circulation in the community.
Since coronavirus disease 2019 (COVID-19) became a global pandemic, repurposing known drugs was the quickest way to combat the disease. The initial screening revealed that azithromycin (AZM) might ...have potential against COVID-19. Although clinical trials did not prove such efficacy, many countries have put AZM within their guidelines for treating COVID-19. Therefore, the present study was designed to assess the misuse of AZM in Jordan during the COVID-19 pandemic.
A cross-sectional study was conducted among community pharmacies in Jordan from March 27 to May 8, 2021, and 184 pharmacies data were collected from the Google forms. During COVID-19, 42.9% of pharmacies sold more than 20 packs of prescribed AZM per month compared to 46.7% of pharmacies used to sell 0-5 packs AZM prescriptions per month before the pandemic. During COVID-19, pharmacists significantly dispensed AZM with and without prescriptions 107% and 127%, respectively, more than before the pandemic (p < 0.0001). Overall, pharmacists stocked 121% more AZM packs during COVID-19 than before the pandemic (p < 0.0001). Additionally, most pharmacists (59.7%) believed that AZM could cure COVID-19 patients. However, using multinomial logistic regression analysis, low-experienced pharmacists were unsure if AZM could positively affect COVID-19 patients (p < 0.05, OR = 3.76, 95% CI = 1.23-11.52). Furthermore, low-experienced pharmacists believed that increased use of AZM for the treatment of viral infections could lead to negative consequences (p < 0.001, OR = 0.161, 95% CI 0.063-0.414).
This study demonstrated that AZM is misused by physicians, pharmacists, and the public in Jordan. Since AZM efficacy on SARS-CoV-2 is scarce, there is a need for new guidelines by governmental health authorities to implement strict enforcement of AZM dispensing during COVID-19 to avoid negative consequences of bacterial resistance.
A large prospective, open‐label, randomized trial evaluated conversion from calcineurin inhibitor (CNI)‐ to sirolimus (SRL)‐based immunosuppression for preservation of renal function in liver ...transplantation patients. Eligible patients received liver allografts 6–144 months previously and maintenance immunosuppression with CNI (cyclosporine or tacrolimus) since early posttransplantation. In total, 607 patients were randomized (2:1) to abrupt conversion (<24 h) from CNI to SRL (n = 393) or CNI continuation for up to 6 years (n = 214). Between‐group changes in baseline‐adjusted mean Cockcroft–Gault GFR at month 12 (primary efficacy end point) were not significant. The primary safety end point, noninferiority of cumulative rate of graft loss or death at 12 months, was not met (6.6% vs. 5.6% in the SRL and CNI groups, respectively). Rates of death at 12 months were not significantly different, and no true graft losses (e.g. liver transplantation) were observed during the 12‐month period. At 52 weeks, SRL conversion was associated with higher rates of biopsy‐confirmed acute rejection (p = 0.02) and discontinuations (p < 0.001), primarily for adverse events. Adverse events were consistent with known safety profiles. In conclusion, liver transplantation patients showed no demonstrable benefit 1 year after conversion from CNI‐ to SRL‐based immunosuppression.
Conversion from calcineurin inhibitor to sirolimus‐based immunosuppression for preservation of renal function in liver transplant recipients shows no demonstrable benefit at one year. See editorial by McKenna and Trotter on page 521.
Background
Frontal sinus carcinoma is commonly seen as an extension of the ethmoid sinus, overlying skin, or lacrimal gland. The existence of this disease has been unclear. We aimed to describe the ...occurrence of primary frontal sinus carcinoma.
Methods
We conducted a systematic literature review and a retrospective review of the medical records at our institution in the past 10 years.
Results
Sixty-four articles were included in the literature review. Most frontal sinus carcinomas involved surrounding structures as the sphenoid or ethmoid sinus, and a primary origin in the frontal sinus could not be confirmed. No cases of primary frontal sinus carcinoma were identified at our hospital.
Conclusion
Isolated primary frontal sinus carcinoma, if exists, is very rare. There is uncertainty regarding the primary origin of frontal sinus carcinoma in most studies. The frontal sinus seems to be immune from primary carcinoma. Further studies are needed to explain such immunity.
Key points
• Frontal sinus being the primary site for carcinoma is extremely rare.
• The diagnosis of primary frontal sinus carcinoma remains questionable, as it is commonly seen as an extension of the ethmoid sinus, overlying skin, or lacrimal gland.
• There was uncertainty regarding the primary origin of the frontal sinus tumor in most studies.
• No cases of primary frontal sinus carcinoma were identified at our hospital.
• The cause of the rarity of occurrence of primary frontal sinus carcinoma is still not known.
• Further studies are needed to explain such invulnerability or immunity.
Asymptomatic carriage of methicillin-resistant Staphylococci (MRS) may allow for the unseen dissemination of antibiotic-resistant strains through the population. This study investigates the ...prevalence and epidemiological risk factors that contribute to the spread of MRS in a university setting in Amman, Jordan. A cross-sectional questionnaire-based study was performed in December 2019. Five hundred and four students enrolled in the study and provided skin and nasal swabs. Swabs were then processed to isolate MRS on Mannitol Salt Agar (MSA) + 4 µg/ml oxacillin. Isolates were tested for their antibiotic susceptibility using the disc diffusion assay. Epidemiological risk assessment was performed using the Chi-square test and univariate and multivariant analysis. The percentage carriage of MRS in the 504 students was 40.4%. The carriage rate of methicillin-resistant
Staphylococcus aureus
(MRSA) and methicillin-resistant
Staphylococcus epidermidis
(MRSE) from the skin and nasal areas was 13.5% and 26.9%, respectively. The percentage of male carriers was significantly higher than females, and the only identified epidemiological risk factor related to the carriage was attendance at a fitness club. All MRS isolates were resistant to oxacillin (100%), cefoxitin (45.5%), erythromycin (35.2%), gentamycin (10.2%), ciprofloxacin (12.7%), nitrofurantoin (12.2%), linezolid (7.8%), amikacin (1.47%), and Vancomycin (0.49%). 42% of MRS expressed a multiple antibiotic resistance (MAR) index above 0.2. Three isolates expressed a MAR index of 0.8. MRS has been exhibited to be present in an otherwise healthy population of students, which may then act as a reservoir for MAR strains.
The aim of this study was to evaluate the criterion validity of the IHT and the SLHB against isokinetic dynamometry, and to assess the test-retest reliability of the IHT and the SLHBT. Methods: The ...study employed a cross-sectional criterion validity and test-retest reliability design. Test-retest reliability was determined using intraclass correlation (ICC2,1 model).
Maladie de Morbihan (MM), connue aussi sous le nom de l’œdème facial persistant solide, est une entité rare de nosologie incertaine, considérée comme une forme compliquée de le rosacée, appelée aussi ...rosacée lymphœdémateuse. Sa physiopathologie n’est pas bien connue posant un véritable problème de prise en charge thérapeutique.
Nous en rapportons une nouvelle observation.
On rapporte le cas d’un homme âgé de 56 ans, sans antécédents, qui consultait pour érythrœdème évoluant depuis 11 ans prédominant au niveau des paupières et des joues entraînant une occlusion palpébrale gauche. La peau en regard des joues était indurée a surface mamelonnée. Il présente aussi une rhinophyma.
À la dermoscopie, un fond rosé avec des aires jaune-orangées, parsemé de télangiectasies en polygone et de demodex. Le bilan biologique était sans anomalie. On a complété par un kit myositis qui était négatif. Le dosage de la C1 inhibiteur était normal. Un examen ORL spécialisé et un examen ophtalmologique étaient sans anomalies. Une biopsie cutanée faite au niveau des paupières a montré un remaniement inflammatoire périvasculaire avec ectasie vasculaire sans granulome épitheloïde et une autre biopsie au niveau des joues qui a montré une dermite granulomateuse sans nécrose. Devant la négativité du bilan étiologique et l’aspect histologique, le diagnostic de maladie de Morbihan a été retenu. Un traitement par cyclines per os a été prescrit en association avec une blépharoplastie et un traitement diurétique (furosémide a la dose de 60mg/j) et une régression partielle de l’œdème était constatée au bout de 5 semaines.
MM est une complication rare de la rosacée qui peut survenir à tout stade et même en l’absence de signes cliniques évoquant cette dermatose. Certains auteurs ont suggéré qu’une obstruction lymphatique par un granulome périlymphatique pourrait être impliquée dans la genèse des lésions, mais les mécanismes physiopathologiques restent incertains. L’aspect clinique caractéristique est un œdème bilatéral prédominant au niveau du front, des paupières, la région nasale et les joues. Cet œdème, d’abord récurrent devient persistant sans tendance à l’involution spontanée et peut conduire à une induration fibreuse.
Le diagnostic est retenu après l’exclusion de certains diagnostics tel que : le lupus érythémateux chronique ; la dermatomyosite ; la sarcoïdose et le syndrome de Merkelson-Rosenthal dans sa forme atypique avec atteinte du front et des paupières.
La prise en charge reste empirique en l’absence d’un consensus clair. Plusieurs traitements ont été proposés avec des résultats variables, notamment les cyclines, le métronidazole, les corticoïdes, l’isotrétinoïne en association au kétotifène, les anti-aldostérones. Une fois il y a une résistance au traitement médical, on peut envisager la chirurgie plastique qui, suivi par un drainage lymphatique ou une blépharoplastie par laser CO2, semble intéressante. L’efficacité du traitement diurétique isolé ou en association a la blépharoplastie dans les formes sévères, a été largement rapportée au cours des dernières années. Le mécanisme d’action pourrait être lié à l’action des diurétiques sur le système des prostaglandines.
La MM associe des œdèmes palpébraux, cortico-résistants, à répétition, évoluant par poussées, de façon chronique, dans un contexte de rosacée. L’examen anatomo-pathologique montre une inflammation aspécifique et élimine surtout une prolifération lymphomateuse. Le patient devra être prévenu du risque de récidive, restant cependant rare en l’absence de nouvelles poussées.
Purpose: The development of effective treatments for coronavirus infectious disease 19 (COVID-19) caused by SARS-Coronavirus-2 was hindered by the little data available about this virus at the start ...of the pandemic. Drug repurposing provides a good strategy to explore approved drugs' possible SARS-CoV-2 antiviral activity. Moreover, drug synergism is essential in antiviral treatment due to improved efficacy and reduced toxicity. In this work, we studied the effect of approved and investigational drugs on one of SARS-CoV -2 essential proteins, the main protease (M (pro) ), in search of antiviral treatments and/or drug combinations. Methods: Different possible druggable sites of M (pro) were identified and screened against an in-house library of more than 4000 chemical compounds. Molecular dynamics simulations were carried out to explore conformational changes induced by different ligands' binding. Subsequently, the inhibitory effect of the identified compounds and the suggested drug combinations on the Mpro were established using a 3CL protease (SARS-CoV-2) assay kit. Results: Three potential inhibitors in three different binding sites were identified; favipiravir, cefixime, and carvedilol. Molecular dynamics simulations predicted the synergistic effect of two drug combinations: favipiravir/cefixime, and favipiravir/carvedilol. The in vitro inhibitory effect of the predicted drug combinations was established on this enzyme. Conclusion: In this work, we could study one of the promising SARS-CoV-2 viral protein targets in searching for treatments for COVID-19. The inhibitory effect of several drugs on M (pro) was established in silico and in vitro assays. Molecular dynamics simulations showed promising results in predicting the synergistic effect of drug combinations. Keywords: molecular dynamics simulations, ligand docking, multiple binding sites, drug synergy, SARS-CoV-2
Purpose: To evaluate the ocular manifestations of post-acute COVID-19 syndrome. Methods: A retrospective, comparative study included 100 patients who had recovered from COVID-19 and 100 controls who ...were recruited by stratified randomization from hospital registration system and analyzed regarding history, full ophthalmological examination, general examination including internal medicine and neurological evaluation. Laboratory tests were done. Results: Mean+ or -SD of age were 55.5 + or - 6.2 in COVID group vs 56.5 + or - 5.8 in control group; P value = 0.7. In COVID group, 57 patients (57%) were males vs 51 patients (51%) in control group (P value = 0.39), the other compared parameters including history and risk factors showed non-significant difference except for ESR and D-dimer which were elevated in COVID group. In COVID group, 5 patients (5%) were having retinal vascular occlusion, 2 patients (2%) were having anterior ischemic optic neuropathy AION, 3 patients (3%) were having uveitis and 2 patients (2%) were having central serous chorioretinopathy CSCR. While in control group, 2 patients (2%) were having retinal vascular occlusion, and none had AION, uveitis or CSCR (P value = 0.006). Conclusion: Post-acute COVID-19 syndrome could affect the eyes in the form of coagulation problems, neurological morbidities, and other manifestations. This necessitates meticulous follow-up of recovered patients from COVID-19. Keywords: eye, post-acute COVID-19, Upper Egypt, coagulation, follow-up
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