Molecular Basis of Antimicrobial Resistance in Group B Streptococcus Clinical Isolates from Saudi Arabia

Maha Alzayer,1 Manal M Alkhulaifi,2 Ahmed Alyami,3 Mohammed S Aldosary,3 Abdulaziz Alageel,3 Ghada Garaween,1 Nada Alsalloum,1 Atef Shibl,1 Arif M Al-Hamad,4 Michel Doumith5 1Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 2Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia; 3Pathology and Clinical Laboratory, Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia; 4Division of Clinical Microbiology, Pathology and Laboratory Medicine, Qatif Central Hospital, Qatif, Saudi Arabia; 5Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi ArabiaCorrespondence: Maha Alzayer, College of Medicine, Microbiology Department, Al Faisal University, PO Box 50927, Riyadh, 11533, Saudi Arabia, Email [email protected]; [email protected]: Published data on the molecular mechanisms underlying antimicrobial resistance in Group B Streptococcus (GBS) isolates from Saudi Arabia are lacking. Here, we aimed to determine the genetic basis of resistance to relevant antibiotics in a collection of GBS clinical isolates (n = 204) recovered from colonized adults or infected patients and expressing serotypes Ia, Ib, II, III, V, and VI. Initial susceptibility testing revealed resistance to tetracycline (76.47%, n = 156/204), erythromycin (36.76%, n = 75/204), clindamycin (25.49%, n = 52/204), levofloxacin (6.37%, n = 13/204), and gentamicin (2.45%, n = 5/204). Primers designed for the detection of known resistance determinants in GBS identified the presence of erm(A), erm(B), mef(A), and/or lsa(C) genes at the origin of resistance to macrolides and/or clindamycin. Of these, erm(B) and erm(A) were associated with the cMLSB (n = 46) and iMLSB (n = 28) phenotypes, respectively, while mef(A) was linked to the M phenotype (n = 1) and lsa(C) was present in isolates with the L phenotype (n = 8). Resistance to tetracycline was mainly mediated by tet(M) alone (n = 112) or in combination with tet(O) (n = 10); the remaining isolates carried tet(O) (n = 29), tet(L) (n = 2), or both (n = 3). Isolates resistant to gentamicin (n = 5) carried aac(6′)-Ie-aph(2′)-Ia, and those exhibiting resistance to levofloxacin (n = 13) had alterations in GyrA and/or ParC. Most isolates with the erm gene (93.24%, n = 69/74) also had the tet gene and were therefore resistant to erythromycin, clindamycin, and tetracycline. Overall, there were no clear associations between serotypes and resistance genotypes except for the presence of erm(B) in serotype Ib isolates. Dissemination of antibiotic resistance genes across different serotypes represents a public health concern that requires further surveillance and appropriate antibiotic use in clinical practice.Keywords: antibiotic resistance, gene resistance, macrolides, levofloxacin, gentamicin, Group B Streptococcus (GBS

Successful treatment of Premenstrual dysphoric disorder with irritable bowel syndrome using sulpiride

Introduction Premenstrual dysphoric disorder (PMDD) is prevalent, more severe than premenstrual syndrome(PMS), and a challenging disorder. The first line of treatment is pharmacotherapy. Non-pharmacological therapy includes aerobic exercise, consumption of complex carbohydrates and frequent meals, relaxation training, light therapy, sleep deprivation, and cognitive-behavioral therapy could be helpful Objectives To our knowledge, there have not yet been any studies on this treatment option for PMDD with IBS Methods a case report Results A lady suffering from PMDD and irritable bowel syndrome (IBS) did not respond to antidepressants, painkillers, and melatonin. She used to sit at home and in her room these days, waiting for the PMDD severity to decrease. Her condition reached remission after taking a small dosage of sulpiride and stopped on the last day of the period. The patient is satisfied with the result since concerns about antidepressants are addressed and avoided. This case provides a new approach to using low-dosage sulpiride temporarily every month in patients with both PMDD and IBS Conclusions Premenstrual dysphoric disorder is a challenging condition. The symptoms of PMDD are not continuous, and somatic symptoms are a significant component of both the diagnosis and the patient’s suffering. Choosing a suitable medication based on pros and cons contributes to successful treatment and patient satisfaction. This case provides a new approach to using low-dosage sulpiride in patients with both PMDD and IBS, but more studies are needed to confirm its efficacy and safety. Disclosure of Interest None Declare

Postgraduate students’ mental health, it is the time to be aware and act.

Introduction Education is markedly associated with well‐being, leading to the acquisition of healthy behaviors while at the same increasing hiring and salary. However, stress among academics is worrying, especially in younger researchers who experience significant levels of job insecurity, the imbalances between life and job, stressful relationships with supervisors and funding difficulties. Several studies have indicated that most graduate students spent over 40 hours per week on their postgraduate program, more than 70 % were not able to complete their programs within the set timeframe, and had uncertainty related to their job Objectives In this review, we discuss the mental health of postgraduate students focusing on depression, anxiety, stress, and smartphone addiction. Methods a review presentation of the mental health of postgraduate Results According to meta-analysis, depression prevalence among postgraduate participants ranges from 6.2% to 85.4% in 36 studies. The pooled prevalence was 34% (26,579 individuals; 95% CI: 28–40). A study using the GAD-7 scale to evaluate the prevalence of anxiety concluded that 41% of postgraduate students suffered moderate to severe GAD, which is about six times the prevalence of GAD among the general population. A Study demonstrated 51.0% of the participants had smartphone addiction. A significant association was also observed between extensive smartphone use and depression (P = 0.001). Of the smokers in this study, 41.5% were addicted to smartphones (P = 0.039). Smartphone addicts had approximately two times the chance of having insomnia (OR = 2.113) (P = 0.013). In addition, they showcased more ADHD symptoms (OR = 2.712) (P < 0.001). Conclusions Studies identified a higher prevalence of mental illnesses among postgraduate students than in the general population. Although students affected are highly educated, their awareness of mental health is not sufficient to know their mental symptoms and seek help. Therefore, we suggest launching wellness programs to enhance their mental health. Disclosure of Interest None Declare

Bezpieczeństwo hematologiczne olanzapiny

Olanzapine is an atypical antipsychotic medication, previously expected to be safe in terms of hematological side effects and considered an alternative choice to clozapine in patients who develop hematotoxicities. However, since olanzapine was introduced to the market many case reports have been published revealing that it could cause hematoxicity. Some of these reports also indicated that olanzapine induced agranulocytosis. Therefore, we conducted a systemic review to explore and address this issue. Electronic database searches from 1998 to 2015 yielded 35 case reports of olanzapine-induced leukopenia and three related systematic reviews. The onset of leukopenia for the majority of these case reports followed in the first month of administration of olanzapine. Moreover, more than two third of these cases never developed drug-related leukopenia before the use of olanzapine. The ages of affected individuals were 16 to 83 years old and their races were African, Caucasian, Asian, Jewish and Mediterranean. The doses of olanzapine ranged from 2.5 to 30 mg. Interestingly, olanzapine was associated with third highest incidence of neutropenia among antipsychotics. The mechanism of olanzapine-induced neutropenia is still unknown, but could be similar to clozapine because of similar chemical composition. Therefore we recommend that the guidelines regarding olanzapine need to be reconsidered and closely monitored with patients being treated with olanzapine for hematological side effects.Olanzapina to nietypowy lek przeciwpsychotyczny, dotychczas uznawany za bezpieczny pod względem hematologicznym i stosowany jako alternatywa dla klozapiny u pacjentów z objawami hemotoksyczności. Jednak od czasu wprowadzenia tego leku na rynek pojawiło się wiele doniesień dotyczących jego hematologicznych działań niepożądanych. Niektóre z tych prac wskazują także, że olanzapina może wywoływać agranulocytozę. Celem przeprowadzonego przeglądu systematycznego było zbadanie tego zagadnienia. W elektronicznych bazach danych z lat 1998–2015 odnaleziono 35 doniesień dotyczących leukopenii indukowanej olanzapiną oraz trzy podobne przeglądy systematyczne. W większości przypadków leukopenia rozwijała się po pierwszym miesiącu stosowania tego leku. Ponadto w ponad dwóch trzecich przypadków leukopenia nie występowała w przeszłości. Pacjenci byli w wieku 16–83 lat i należeli do ras afrykańskiej, kaukaskiej, azjatyckiej, żydowskiej i śródziemnomorskiej. Olanzapinę stosowano w dawkach od 2,5 do 30 mg. Co ciekawe, lek ten był na trzecim miejscu wśród leków przeciwpsychotycznych pod względem wywoływania neutropenii. Mechanizm neutropenii wywołanej olanzapiną pozostaje nieznany, ale może być zbliżony do klozapiny ze względu na podobny skład chemiczny. W związku z powyższym uważamy, że wytyczne dotyczące olanzapiny należy na nowo przemyśleć, a pacjentów stosujących ten lek trzeba obserwować pod kątem występowania hemotoksyczności

Hematological safety of olanzapine

Olanzapine is an atypical antipsychotic medication, previously expected to be safe in terms of hematological side effects and considered an alternative choice to clozapine in patients who develop hematotoxicities. However, since olanzapine was introduced to the market many case reports have been published revealing that it could cause hematoxicity. Some of these reports also indicated that olanzapine induced agranulocytosis. Therefore, we conducted a systemic review to explore and address this issue. Electronic database searches from 1998 to 2015 yielded 35 case reports of olanzapine-induced leukopenia and three related systematic reviews. The onset of leukopenia for the majority of these case reports followed in the first month of administration of olanzapine. Moreover, more than two third of these cases never developed drug-related leukopenia before the use of olanzapine. The ages of affected individuals were 16 to 83 years old and their races were African, Caucasian, Asian, Jewish and Mediterranean. The doses of olanzapine ranged from 2.5 to 30 mg. Interestingly, olanzapine was associated with third highest incidence of neutropenia among antipsychotics. The mechanism of olanzapine-induced neutropenia is still unknown, but could be similar to clozapine because of similar chemical composition. Therefore we recommend that the guidelines regarding olanzapine need to be reconsidered and closely monitored with patients being treated with olanzapine for hematological side effects

Identifying the needed knowledge and skills for health education specialists: qualitative study with stakeholders in Saudi Arabia

Abstract Background Health education specialists play a major role in promoting a healthy lifestyle, preventing, and managing diseases. This study aimed at identifying the needed skills and knowledge of health education specialists with an interest in disease prevention and the transformation of healthcare in Saudi Arabia. Methods This study employed a qualitative case study approach, using focus group interviews. The study was conducted at King Saud University with three different stakeholder groups (alumni, employers, and faculty members) using convenience sampling. Data was analyzed using thematic analysis. Results We have conducted four focus group interviews with a total of 29 participants. We have identified five main themes from the data; Medical and clinical related knowledge and skills, Communication and engagement with the community, Planning and evaluating health programs, Health systems and health policy, and Marketing and technological skills. Participants highlighted the need to respond to the changing demands of the labor market, the different roles of health education specialists, and patient education vs. public education. Counseling and behavior change were viewed as key roles of health education specialists. In addition to the skills needed to create content and conduct research. Furthermore, equipping health education graduates in the fields of digital health and occupational health was viewed as a key factor in improving their employability and readiness for the labor market. Conclusion Study participants identified multiple skills and knowledge gaps which were deemed important to improve the quality of graduates from the health education program. Future studies are recommended to estimate their importance based on the rating of alumni, faculty staff, and employers. </jats:sec