Low incidence of hypervirulent clinical klebsiella pneumoniae producing carbapenemases among Jordanian hospitalized patients

Background:  Klebsiella species are widely present in the environment and colonize mucosal surfaces of humans. The organism is responsible for various community and hospital-acquired infections. Increased incidence of isolates producing K .pneumoniae carbapenemases (KPCs)  in infected patients has become a significant problem in many countries, especially those new hypervirulent clinical variant (hvKP).  This prospective study was intended to detect the incidence, virulence factors and carbapenems resistant gene (blakpc2) in K. pneumoniae isolates among Jordanian patients.Methods:  A total of 104 klebsiella species isolates were collected randomly from three major hospitals in Amman, Jordan, over the period from September 2012 to October 2013. These isolates were investigated for incidence of  K.pneumoniae , antimicrobial susceptibility and detection of virulence factors and kpc gene using PCR .Results: A total of 75 (72%) of the collected isolates were confirmed as K. pneumoniae using PCR, and 74% of these were MDR to at least 3 antibiotic classes. The percentage of the virulence factors K1, K2, K5, rmpA and aerobactin were 0%, 4%, 0%, 5.3% and 10.7%, respectively. Resistant to cabapenems was detected in 18/75 (24% ) of K . pneumoniae isolates, and 10 (13.3%) of these have the kpc genes .Conclusion: This study confirms the high incidence rate of MDR K. pneumoniae and low incidence of (KPCs) isolates in Jordanian patients.  There were few isolates associated with virulence factor genes causing hvKP, and no significant correlation demonstrated between the presence of virulence factors and kpc gene in these isolates

Conspiracy Beliefs Are Associated with Lower Knowledge and Higher Anxiety Levels Regarding COVID-19 among Students at the University of Jordan

The world has been afflicted heavily by the burden of coronavirus disease 2019 (COVID-19) that overwhelmed health care systems and caused severe economic and educational deficits, in addition to anxiety among the public. The main aim of this study was to evaluate the mutual effects of belief that the pandemic was the result of a conspiracy on knowledge and anxiety levels among students at the University of Jordan (UJ). An electronic-based survey was conducted between 29 March, 2020 and 31 March, 2020. The targeted population involved all undergraduate and postgraduate students from the health, scientific and humanities schools at UJ. Survey sections included 26 items on: socio-demographic information, knowledge and sources of information about the disease, attitude towards the false notion that COVID-19 stemmed from a conspiracy and items to assess the anxiety level among students during the quarantine period. The total number of participants was 1540 students. The mean age of study participants was 22 years and females predominated the study population (n = 1145, 74.4%). The majority of participants perceived the disease as moderately dangerous (n = 1079, 70.1%). Males, Jordanians and participants with lower income were more inclined to feel that COVID-19 is very dangerous. A lower level of knowledge and a higher level of anxiety about COVID-19 were associated with the belief that the disease is part of a conspiracy. Females and participants with lower income were more likely to believe that the disease is related to conspiracy. Belief in conspiracy regarding the origin of COVID-19 was associated with misinformation about the availability of a vaccine and the therapeutic use of antibiotics for COVID-19 treatment. The Ministry of Health in Jordan was the most common source of information about COVID-19 reported by the participants (n = 1018). The false belief that COVID-19 was the result of a global conspiracy could be the consequence of a lower level of knowledge about the virus and could lead to a higher level of anxiety, which should be considered in the awareness tools of various media platforms about the current pandemic

High incidence of multidrug-resistant fecal E. coli producing ESBLs and carried ST131 in Jordanian adults

Background: Escherichia coli  is part of the human intestine normal flora, although it has the potential of causing variety of invasive and diarrheal diseases. It is also a frequent cause of community- and hospital-acquired urinary tract infections. Intestinal E. coli has the potential to develop rapidly multidrug resistant (MDR) and to emerge as extended-spectrum β-lactamases (ESBLs)-producer.    Methods: Over the period of July through November, 2015; 287 stool samples were collected from Jordanian adults who visited the students’ clinic of the University of Jordan. Fecal samples were collected and cultured for isolation of E. coli. The isolates were investigated for antimicrobial susceptibility, and molecular method of polymerase chain reaction (PCR) was performed for the detection genes of ST131 clone, blaCTX-M group I, blaCTX-M-15, blaNDM-1, blaVIM, blaIMP, blaOXA-48, blaKPC and fluoroquinolones resistance (gyrA and parC). Results: A total of 105/287 E. coli isolates (36.6%) were found to be multi-drug resistant (MDR) to at least 3 classes of antibiotics, of these 45.1% were ESBL-producers. A total of 51 representative MDR isolates indicated the following; 49% were found positive for ST131 clone, 58.8% were resistant for ciprofloxacin, and 41.2% were positive for CTX-M group I and CTX-M-15, respectively. All these MDR isolates were also positive for mutated both gyrA and ParC genes, and only 6 / 51 isolates (11.8%) were positive for each blaNDM-1 and blaKPC.  One out of 51 MDR isolates (2%) was positive for blaVIM, and none of these isolates was positive for blaIMP nor blaOXA-48 genes. Conclusion: This study indicated that a relatively high rates of commensal fecal E. coli isolates from Jordanian adults were MDR, ESBLs-producer and belonging to ST131 clone.  Also, high rates of CTX-M-15 and fluoroquinolones resistance were found among MDR E. coli isolates.   &nbsp

The Etiology of Viral Lower Respiratory Tract Infections at a Tertiary Hospital in Jordan over Five Years

Background Lower respiratory tract infection (LRTI) is the most common condition treated in primary care and is considered the third leading cause of death worldwide. The objective of our study is to determine the etiological agents that cause viral LRTI in Jordan, aiming to help physicians to choose the appropriate treatment strategy. Materials and Methods We conducted a retrospective study on patients who were admitted with the diagnosis of LRTI between January, 2011 and January, 2016. We used Fast-track Diagnostics (FTD)® Respiratory 21 Kit (Fast-track Diagnostics, Luxembourg) real-time PCR to determine the viral etiology of LRTI, and we investigated pandemic H1N1 2009 swine flu virus using rapid test PCR. Results This study involved 495 patients with a mean age of 57.79 ± 18.43 years. The causative agents were identified in 157 patients out of 495 patients (31.7%). FTD real-time PCR was done for 170 patients, and the test was positive for seasonal Influenza A virus in 7.1% of patients, influenza B in 4.1%, RSV in 4.7%, metapneumovirus in 4.1%, adenovirus in 4.1%, corona 229E/NL63 in 4.1%, parainfluenza virus in 7.6%, and rhinovirus in 3.5%. The percent of cases who were positive for pandemic H1N1 2009 swine flu virus was 4.2%. The rate of ICU admission was 16.8%, and the mortality rate of LRTI was as low as 3.64%. Conclusions Viral LRTI is more common in winter season in Jordan, especially in January. Remarkably, Influenza A and Parainfluenza viruses were the main viral causative agents for LRTI in our study

Molecular Analysis of SARS-CoV-2 Genetic Lineages in Jordan: Tracking the Introduction and Spread of COVID-19 UK Variant of Concern at a Country Level

The rapid evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is manifested by the emergence of an ever-growing pool of genetic lineages. The aim of this study was to analyze the genetic variability of SARS-CoV-2 in Jordan, with a special focus on the UK variant of concern. A total of 579 SARS-CoV-2 sequences collected in Jordan were subjected to maximum likelihood and Bayesian phylogenetic analysis. Genetic lineage assignment was undertaken using the Pango system. Amino acid substitutions were investigated using the Protein Variation Effect Analyzer (PROVEAN) tool. A total of 19 different SARS-CoV-2 genetic lineages were detected, with the most frequent being the first Jordan lineage (B.1.1.312), first detected in August 2020 (n = 424, 73.2%). This was followed by the second Jordan lineage (B.1.36.10), first detected in September 2020 (n = 62, 10.7%), and the UK variant of concern (B.1.1.7; n = 36, 6.2%). In the spike gene region, the molecular signature for B.1.1.312 was the non-synonymous mutation A24432T resulting in a deleterious amino acid substitution (Q957L), while the molecular signature for B.1.36.10 was the synonymous mutation C22444T. Bayesian analysis revealed that the UK variant of concern (B.1.1.7) was introduced into Jordan in late November 2020 (mean estimate); four weeks earlier than its official reporting in the country. In Jordan, an exponential increase in COVID-19 cases due to B.1.1.7 lineage coincided with the new year 2021. The highest proportion of phylogenetic clustering was detected for the B.1.1.7 lineage. The amino acid substitution D614G in the spike glycoprotein was exclusively present in the country from July 2020 onwards. Two Jordanian lineages dominated infections in the country, with continuous introduction/emergence of new lineages. In Jordan, the rapid spread of the UK variant of concern should be monitored closely. The spread of SARS-CoV-2 mutants appeared to be related to the founder effect; nevertheless, the biological impact of certain mutations should be further investigated.</jats:p

Molecular Analysis of SARS-CoV-2 Genetic Lineages in Jordan: Tracking the Introduction and Spread of COVID-19 UK Variant of Concern at a Country Level

The rapid evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is manifested by the emergence of an ever-growing pool of genetic lineages. The aim of this study was to analyze the genetic variability of SARS-CoV-2 in Jordan, with a special focus on the UK variant of concern. A total of 579 SARS-CoV-2 sequences collected in Jordan were subjected to maximum likelihood and Bayesian phylogenetic analysis. Genetic lineage assignment was undertaken using the Pango system. Amino acid substitutions were investigated using the Protein Variation Effect Analyzer (PROVEAN) tool. A total of 19 different SARS-CoV-2 genetic lineages were detected, with the most frequent being the first Jordan lineage (B.1.1.312), first detected in August 2020 (n = 424, 73.2%). This was followed by the second Jordan lineage (B.1.36.10), first detected in September 2020 (n = 62, 10.7%), and the UK variant of concern (B.1.1.7; n = 36, 6.2%). In the spike gene region, the molecular signature for B.1.1.312 was the non-synonymous mutation A24432T resulting in a deleterious amino acid substitution (Q957L), while the molecular signature for B.1.36.10 was the synonymous mutation C22444T. Bayesian analysis revealed that the UK variant of concern (B.1.1.7) was introduced into Jordan in late November 2020 (mean estimate); four weeks earlier than its official reporting in the country. In Jordan, an exponential increase in COVID-19 cases due to B.1.1.7 lineage coincided with the new year 2021. The highest proportion of phylogenetic clustering was detected for the B.1.1.7 lineage. The amino acid substitution D614G in the spike glycoprotein was exclusively present in the country from July 2020 onwards. Two Jordanian lineages dominated infections in the country, with continuous introduction/emergence of new lineages. In Jordan, the rapid spread of the UK variant of concern should be monitored closely. The spread of SARS-CoV-2 mutants appeared to be related to the founder effect; nevertheless, the biological impact of certain mutations should be further investigated

An In vitro Evaluation of the Antimicrobial Activity of Nine Root Canal Sealers

Abstract Aim The purpose of this in vitro study was to analyze the antimicrobial activity of root canal sealers by using the agar diffusion test (ADT). Methods and Materials Three categories of root canal sealers were included in the study: resin-based sealers (4), zinc oxide-based sealers (3), and calcium hydroxide-based sealers (2). The microbial strains used were: S. aureus (2 strains), C. albicans (2 strains), and E. faecalis (1 strain). Statistical analysis was conducted using a one-way analysis of variance (ANOVA). Tests of differences were analyzed using the Tukey's test with a value of p &lt; 0.05 considered statistically significant. Results The antimicrobial activity of root canal sealers was ranked in descending order as follows: Sealite Regular, Cortisemol, Dentalis KEZ, AH26, Sealapex, Acroseal/Topseal, and Endorez/AH plus. Conclusion Root canal sealers showed different inhibitory effects depending on their types and the bacterial strains tested. Root canal sealers containing formaldehyde and eugenol proved to be effective against the microorganisms studied. Clinical Significance The incorporation of antimicrobial components into root canal sealers may become an essential factor in preventing the re-growth of residual bacteria and control of bacteria re-entry into the root canal system. Citation Smadi L, Mahafzah A, Khraisat A. An In vitro Evaluation of the Antimicrobial Activity of Nine Root Canal Sealers. J Contemp Dent Pract 2008 July; (9)5:060-067. </jats:sec

Hepatitis of Unknown Origin and Etiology (Acute Non HepA-E Hepatitis) among Children in 2021/2022 : Review of the Current Findings

Several clusters and individual cases of acute hepatitis have been reported in the US, Europe and recently in Asia and Central America since October 2021. A laboratory investigation of the common viral hepatitis agents (HAV, HBV, HCV, HDV and HEV) yielded negative results prompting the use of the term “acute non HepA-E hepatitis” to describe this condition. The cases were characterized by the manifestations of acute hepatitis (abdominal pain, vomiting, diarrhea, jaundice and very high levels of liver enzymes) affecting children with a median age of 3–4 years. The exact underlying etiology has not been revealed yet; however, a leading hypothesis is that an infectious agent is the culprit, underlying cause or a risk factor for acute non HepA-E hepatitis occurrence. So far, laboratory testing has shown the presence of the group F human adenovirus serotype 41 (HAdV-F41) in about three-fourths of the investigated cases. As of 13 May 2022, more than 450 cases were reported worldwide, the majority of which were in the UK (n = 176), the US (n = 109), 13 European countries (at least 103 cases) and in Argentina, Brazil, Canada, Costa Rica, Indonesia, Israel, Japan, Palestine, Panama, Singapore and South Korea. Vigilant surveillance and epidemiologic investigations to identify further cases are warranted to delineate the features of this emergent public health issue. The possible role of environmental and toxic agents including foodborne toxins should also be considered. Specific guidelines for identification of further cases are necessary, particularly in low-income settings where testing for adenoviruses is not considered routinely. A genetic analysis of HAdV-F41 isolates is recommended to assess the potential changes in the virus genome with subsequent possible altered virus behavior. Immunopathogenesis is another possibility that should be evaluated considering the lack of viral structures in liver biopsies of the affected children in the US

Clusters of Hepatitis of Unknown Origin and Etiology (Acute Non HepA–E Hepatitis) Among Children in 2021/2022: A Review of the Current Findings

Several clusters and individual cases of acute &amp;mdash;often severe&amp;mdash; hepatitis have been reported in Europe &amp;mdash;mainly in the United Kingdom (U.K.)&amp;mdash;, the United States (U.S.) and recently in Asia since October 2021. Laboratory investigation of the common viral hepatitis agents (HAV, HBV, HCV, HDV and HEV) yielded negative results prompting the use of the term &amp;ldquo;acute non hepA&amp;ndash;E hepatitis&amp;rdquo; to describe this condition. The cases were characterized by the manifestations of acute hepatitis (abdominal pain, vomiting, diarrhea, jaundice and very high levels of liver enzymes) affecting children with a median age of 3&amp;ndash;4 years. The exact underlying etiology has not been revealed yet; however, a leading hypothesis is that an infectious agent is the culprit underlying cause or at least a risk factor for acute non hepA&amp;ndash;E hepatitis occurrence. So far, laboratory testing has shown the presence of adenovirus serotype 41 (Ad&amp;ndash;41) which is classified in group F of adenoviruses in about three-fourths of the reported cases. However, the definitive link between adenoviruses and acute non hepA&amp;ndash;E hepatitis has not been fully elucidated, which necessitates further investigation of this possible correlation. As of the end of April 2022, more than 200 cases were reported worldwide, the majority of which were in Europe: the U.K. (n=114), Italy (n=17), Spain (n=13), Israel (n=12), the U.S. (n=9), Denmark (n=6), Netherlands and Ireland (n=4), Japan (n=3), Austria, Belgium, France, and Norway (n=2), Germany, Poland, and Romania (n=1). Possible cases are being evaluated in Illinois, Minnesota, North Carolina, Wisconsin states of the U.S., Canada, Singapore and Slovenia. Vigilant surveillance and epidemiologic investigation to identify further cases are warranted at the global level to delineate the features of this emergent public health issue. The possible role of environmental and toxic agents including foodborne toxins should not be overlooked as well. Specific guidelines for identification of further cases is necessary particularly in low-income settings where testing for adenoviruses is not considered routinely. Genetic analysis of Ad&amp;ndash;41 isolates is recommended to assess the potential changes in virus genome with subsequent possible altered virus behavior. Immunopathogenesis is another possibility that should be examined as well considering the absence of virus detection in liver biopsies of the affected children in the U.S.</jats:p