-
Journal of Pediatric and Adolescent... Aug 2022Cloacal anomalies occur when a fetus's rectum, vagina, and urethra fail to separate and result in 1 common channel at birth. They are commonly managed by complex...
BACKGROUND
Cloacal anomalies occur when a fetus's rectum, vagina, and urethra fail to separate and result in 1 common channel at birth. They are commonly managed by complex reconstruction in the first year of life. This manuscript presents an alternative approach to management in patients with absent or nondilated Mullerian structures.
CASE
Image-guided, combined endoscopic and laparoscopic surgery (CELS) was used to perform an anorectal pull-through at 5 months of age on a patient with persistent cloaca and no definite vaginal or uterine structures seen on MRI and endoscopy. Urogenital reconstruction is delayed until adolescence.
SUMMARY AND CONCLUSION
We hypothesize that performing a minimally invasive anorectoplasty on patients with complicated anatomy and low risk for hydrocolpos could potentially result in improved urologic function and better psychosocial outcomes. Delaying vaginoplasty will enable determination of the function of remnant Mullerian structures and allow the patient to direct the augmentation approach.
Topics: Adolescent; Animals; Cloaca; Female; Gynecologic Surgical Procedures; Humans; Hydrocolpos; Infant, Newborn; Laparoscopy; Rectum; Urethra; Vagina
PubMed: 35124215
DOI: 10.1016/j.jpag.2022.01.014 -
Microbiology Spectrum Feb 2022species are classified as high-priority pathogens due to high prevalence of multidrug resistance from persistent antibiotic use. For infections caused by...
species are classified as high-priority pathogens due to high prevalence of multidrug resistance from persistent antibiotic use. For infections caused by multidrug-resistant isolates, colistin (polymyxin E), a last-resort antibiotic, is a potential treatment option. Treatment with colistin has been shown to lead to emergence of polymyxin resistance. The primary mechanism for colistin resistance is modification of terminal phosphate moieties of lipid A, leading to decreased membrane electronegativity and reducing colistin binding affinity. Detection of these modifications, including the addition of phosphoethanolamine and 4-amino-4-deoxy-l-arabinose (Ara4N), can be used for prediction of colistin resistance using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The objective of this study was to identify lipid A markers for colistin resistance in species and Klebsiella aerogenes (formerly Enterobacter aerogenes). Using a collection of and Klebsiella aerogenes clinical isolates, broth MICs for colistin were determined initially. Subsequently, killing assays were carried out to determine how the concentration of colistin at which there is approximately 50% survival (kill) equates to their MICs. Finally, lipid A analysis was conducted via MALDI-TOF MS using the novel rapid extraction method, termed fast lipid analysis technique (FLAT), to correlate MIC and killing efficacy with predictive lipid A modifications. Sensitivity and specificity of the MS assay compared to MIC interpretation were 100% and 53.4%, respectively. A receiver operator characteristic (ROC) demonstrated that MS was highly correlated with killing, with area under the curve of 0.97. This analysis demonstrated the potential utility of MALDI-TOF MS as a rapid diagnostic platform of colistin resistance in species. In this study, we develop a novel method for identifying colistin resistance in species and Klebsiella aerogenes without performing antimicrobial susceptibility testing. Typically, susceptibility testing requires an additional 24 to 48 h, while the MS assay described in this study allows for resistant identifications in under 1 h after initial culture. Identification using MALDI-TOF MS would save time and prevent inappropriate use of colistin. MALDI-TOF MS is an easy-to-use, readily available, robust diagnostic tool in clinical laboratories. Furthermore, this study highlights limitations of polymyxin susceptibility testing. Use of a killing assay best captures how colistin treats infection and is shown to be highly correlated with our MS assay; thus, the MS assay in this study effectively predicts how colistin would treat a patient's infection. Use of MALDI-TOF MS for accurate and early identification of antimicrobial resistance can improve antimicrobial stewardship and patient outcomes.
Topics: Anti-Bacterial Agents; Colistin; Drug Resistance, Bacterial; Enterobacter; Enterobacteriaceae Infections; Humans; Lipid A; Microbial Sensitivity Tests; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tandem Mass Spectrometry
PubMed: 35107363
DOI: 10.1128/spectrum.01445-21 -
Journal of Pediatric Urology Apr 2022This study reviewed the literature on the laparoscopic management of cloaca. (Review)
Review
AIM
This study reviewed the literature on the laparoscopic management of cloaca.
METHODS
A Medline and Embase search was performed for "laparoscopy" and "cloaca." Articles for which full-text in English was not available, duplicate articles, and review articles were excluded. Demographic characteristics, duration of follow-up, length of common channel, postoperative complications, and functional outcomes were analyzed.
RESULTS
The database search retrieved 81 articles after excluding unrelated articles and identified new articles through cross-referencing 14 articles (72 patients) for this review. The rectal pouch was situated below the pubococcygeal (PC) line in three patients. In all other patients, the rectum was located above the PC line. Only the rectal component of the malformation was repaired laparoscopically in 80% (58/72). Fourteen patients underwent laparoscopic mobilization of the rectum and urogenital component. The length of the common channel was more than 3 cm in all these fourteen patients. The most common complication was rectal prolapse (n = 11). Functional evaluation by Krickenbeck scoring system was reported in 32 patients, of which 6/32 (18.75%) had fecal soiling > Grade 2.
DISCUSSION
Until recently, laparoscopy for the common cloaca was almost exclusively used in patients with low urogenital sinus with high rectal pouch. Moreover, only the rectal component was repaired laparoscopically. Recently, laparoscopic rectal mobilization and urogenital separation was described for patients with common channel length ≥3 cm. It has been reported that laparoscopic vaginal mobilization is easy and more complete by this technique and may avoid vaginal replacement in most of these patients with the long common channel. However, only two studies have reported this technique, and its reproducibility and long-term results are still awaited. Another interesting observation was the increasing use of urethral length along with common channel length in determining the appropriate procedure for the patients with common cloaca. Recent studies propose that the urogenital separation technique be preferred over urogenital mobilization in patients with the short urethra. Nonetheless, we still don't have long-term comparative data to demonstrate that the functional outcomes are better with this new algorithm. We conclude that the persistent cloaca needs an individualized approach, and laparoscopy can be utilized to mobilize the high rectum and is also helpful for the urogenital separation in patients with common channel length >3 cm. However, at present, there is no conclusive evidence to support that laparoscopic repair has a better functional outcome than the open approach.
Topics: Animals; Cloaca; Female; Humans; Laparoscopy; Rectum; Reproducibility of Results; Retrospective Studies
PubMed: 35101384
DOI: 10.1016/j.jpurol.2021.12.014 -
CEN Case Reports Aug 2022Persistent cloaca involves fusion of the bladder, vagina, and rectum into a single duct called the common duct. Although its pathogenesis remains unclear, it has been...
Persistent cloaca involves fusion of the bladder, vagina, and rectum into a single duct called the common duct. Although its pathogenesis remains unclear, it has been associated with hyperchloremic metabolic acidosis. Herein, we present the case of a neonatal girl with high-confluence type variant of persistent cloaca treated with vesicostomy (Blocksom) for refractory metabolic acidosis. She was diagnosed with persistent cloaca before birth; colostomy was performed and a urinary catheter was placed in the bladder. Voiding cystourethrography on day 19 after birth showed that most of the contrast material leaked into the rectum; hence, the urinary catheter was removed. On day 27, hyperchloremic metabolic acidosis was detected and treatment with oral sodium bicarbonate was initiated; however, the infant showed no response. Because hyperchloremia occurred after removal of the urinary catheter, continuous urine retention in the colon through the common duct was believed to have caused the progression of hyperchloremic metabolic acidosis through transporters in the intestinal mucosa. As reinstallation of a urinary catheter was technically difficult, vesicostomy was performed on day 29, after which the metabolic acidosis improved. This report suggests vesicostomy as an effective treatment for refractory hyperchloremic metabolic acidosis associated with high-confluence type persistent cloaca.
Topics: Acidosis; Animals; Cloaca; Colon; Cystostomy; Female; Humans; Infant; Infant, Newborn; Urinary Tract
PubMed: 35099756
DOI: 10.1007/s13730-022-00686-2 -
Frontiers in Nutrition 2021A diverse group of rhizobacteria persists in the rhizospheric soil, on the surface of roots, or in association with rice plants. These bacteria colonize plant root...
A diverse group of rhizobacteria persists in the rhizospheric soil, on the surface of roots, or in association with rice plants. These bacteria colonize plant root systems, enhance plant growth and crop yield. Indigenous rhizobacteria are known to promote soil health, grain production quality and serve as sustainable bioinoculant. The present study was aimed to isolate, identify and characterize indigenous plant growth promoting (PGP) diazotrophic bacteria associated with the rhizosphere of rice fields from different areas of Jammu and Kashmir, India. A total of 15 bacteria were isolated and evaluated for various PGP traits, antagonistic activity against phytopathogens, production of hydrolytic enzymes and biofilm formation under conditions. The majority of the isolated bacteria were Gram-negative. Out of 15 bacterial isolates, nine isolates produced IAA (12.24 ± 2.86 to 250.3 ± 1.15 μg/ml), 6 isolates exhibited phosphate solubilization activity (36.69 ± 1.63 to 312.4 ± 1.15 μg/ml), 7 isolates exhibited rock phosphate solubilization while 5 isolates solubilized zinc (10-18 mm), 7 isolates showed siderophore production, 8 isolates exhibited HCN production, 6 isolates exhibited aminocyclopropane-1-carboxylate (ACC) deaminase activity, 13 isolates exhibited cellulase activity, nine isolates exhibited amylase and lipase activity and six isolates exhibited chitinase activity. In addition, 5 isolates showed amplification with gene and showed a significant amount of nitrogenase activity in a range of 0.127-4.39 μmol CH/mg protein/h. Five isolates viz., IHK-1, IHK-3, IHK-13, IHK-15 and IHK-25 exhibited most PGP attributes and successfully limited the mycelial growth of and oxysporum . All the five bacterial isolates were identified based on morphological, biochemical and 16S rDNA gene sequencing study, as sp., sp., and . Rice plants developed from seeds inoculated with these PGP strains individually had considerably higher germination percentage, seed vigor index and total dry biomass when compared to control. These findings strongly imply that the PGP diazotrophic bacteria identified in this work could be employed as plant growth stimulators in rice.
PubMed: 35096930
DOI: 10.3389/fnut.2021.781764 -
Microbiology Spectrum Feb 2022Prior study has demonstrated that gut microbiota at the genus level is significantly altered in patients with growth hormone (GH)-secreting pituitary adenoma (GHPA)....
Prior study has demonstrated that gut microbiota at the genus level is significantly altered in patients with growth hormone (GH)-secreting pituitary adenoma (GHPA). Yet, no studies exist describing the state of gut microbiota at species level in GHPA. We performed a study using 16S rRNA amplicon sequencing in a cohort of patients with GH-secreting pituitary adenoma (GHPA, = 28) and healthy controls ( = 67). Among them, 9 patients and 10 healthy controls were randomly chosen and enrolled in metagenomics shotgun sequencing, generating 280,426,512 reads after aligning to NCBI GenBank DataBase to acquire taxa information at the species level. Weighted UniFrac analysis revealed that microbial diversity was notably decreased in patients with GHPA, consistent with a previous study. With 16S rRNA sequencing, after correction for false-discovery rate (FDR), rank-sum test at the genus level revealed that the relative abundance of and was remarkably increased in patients and and genera predominated in the controls, augmented by additional LEfSe (linear discriminant analysis effect size) analysis. As for further comparison at the species level with metagenomics sequencing, rank-sum test together with LEfSe analysis confirmed the enrichment of Alistipes shahii and Odoribacter splanchnicus in the patient group. Notably, LEfSe analysis with metagenomics also demonstrated that sp. and sp. , derived from , were both significantly enriched in patients. Functional analysis showed that amino acid metabolism pathway was remarkably enriched in GHPA, while carbohydrate metabolism pathway was notably enriched in controls. Further, significant positive correlations were observed between and baseline insulin-like growth factor 1 (IGF-1), indicating that may be strongly associated with GH/IGF-1 axis in GHPA. Our data extend our insight into the GHPA microbiome, which may shed further light on GHPA pathogenesis and facilitate the exploration of novel therapeutic targets based on microbiota manipulation. Dysbiosis of gut microbiota is associated not only with intestinal disorders but also with numerous extraintestinal diseases. Growth hormone-secreting pituitary adenoma (GHPA) is an insidious disease with persistent hypersecretion of GH and IGF-1, causing increased morbidity and mortality. Researches have reported that the GH/IGF-1 axis exerts its own influence on the intestinal microflora. Here, the results showed that compared with healthy controls, GHPA patients not only decreased the alpha diversity of the intestinal flora but also significantly changed their beta diversity. Further, metagenomics shotgun sequencing in the present study exhibited that sp. and sp. were enriched in patients. Also, we were pleasantly surprised to find that the genus was strongly positively correlated with baseline IGF-1 levels. Collectively, our work provides the first glimpse of the dysbiosis of the gut microbiota at species level, providing a better understanding of the pathophysiological process of GHPA.
Topics: Adult; Bacteria; Case-Control Studies; DNA, Bacterial; Dysbiosis; Feces; Female; Gastrointestinal Microbiome; Growth Hormone; Growth Hormone-Secreting Pituitary Adenoma; Humans; Insulin-Like Growth Factor I; Male; Metagenomics; Middle Aged; Phylogeny; RNA, Ribosomal, 16S
PubMed: 35019688
DOI: 10.1128/spectrum.00425-21 -
Journal of Extracellular Vesicles Jan 2022Intestinal commensal bacteria contribute to maintaining gut homeostasis. Disruptions to the commensal flora are linked to the development and persistence of disease. The...
Intestinal commensal bacteria contribute to maintaining gut homeostasis. Disruptions to the commensal flora are linked to the development and persistence of disease. The importance of these organisms is further demonstrated by the widespread ability of enteric viruses to exploit commensal bacteria to enhance viral infection. These viruses interact directly with commensal bacteria, and while the impact of this interaction on viral infection is well described for several viruses, the impact on the commensal bacteria has yet to be explored. In this article, we demonstrate, for the first time, that enteric viruses alter the gene expression and phenotype of individual commensal bacteria. Human and murine norovirus interaction with bacteria resulted in genome-wide differential gene expression and marked changes in the surface architecture of the bacterial cells. Furthermore, the interaction of the virus with bacteria led to increased production of smaller outer membrane vesicles (OMVs). Enhanced production of smaller vesicles was also observed when noroviruses were incubated with other commensal bacteria, indicating a potentially broad impact of norovirus interaction. The vesicle production observed in the in vivo model followed a similar trend where an increased quantity of smaller bacterial vesicles was observed in stool collected from virus-infected mice compared to mock-infected mice. Furthermore, changes in vesicle size were linked to changes in protein content and abundance, indicating that viral binding induced a shift in the mechanism of the OMV biogenesis. Collectively, these data demonstrate that enteric viruses induce specific changes in bacterial gene expression, leading to changes in bacterial extracellular vesicle production that can potentially impact host responses to infection.
Topics: Animals; Bacterial Outer Membrane; Enterobacter cloacae; Extracellular Vesicles; Gastroenteritis; Gastrointestinal Microbiome; Humans; Mice; Microbial Interactions; Norovirus
PubMed: 34981901
DOI: 10.1002/jev2.12172 -
Archives of Microbiology Dec 2021A sustainable technology to eliminate the persistent reactive dyes from the textile effluents discharged indiscriminately in the environment is highly desirous given the...
A sustainable technology to eliminate the persistent reactive dyes from the textile effluents discharged indiscriminately in the environment is highly desirous given the explosive growth of textile industries. The present study investigated the potential of two different bacterial strains, Bacillus cereus SKB12 and Enterobacter hormaechei SKB16 isolated from the dye house effluent sludge in the biotransformation of Reactive Red 198 (RR 198). Process variables such as temperature, pH, shaking conditions and contact time were optimized for the successful decolourization of RR 198. Maximum decolourization of 80% and 85% of RR 198 was achieved at pH 6 and 7, and 40 °C in microaerophilic conditions on treatment with B. cereus and E. hormaechei, respectively. High-Performance Liquid Chromatography (HPLC), and Gas Chromatography-Mass Spectrometry (GC-MS) analyses conducted further affirmed that the decolourization of RR 198 was rather due to biodegradation than biosorption through shift in wavenumbers, retention time variations and the appearance of lesser molecular weight peaks. Degradative pathway for RR 198 predicted based on the enzyme assay data and dye degraded metabolite peaks acquired through GC-MS analysis highlighted the significance of azoreductase and laccase in the degradation of RR 198 into smaller non-toxic compounds. In addition, toxicity assessment through zootoxicological and phytotoxicological experiments using brine shrimp and Vigna radiata validated the detoxified status of the metabolites thus proving the promising potentials of the bacterial strains in the remediation of azo dyes.
Topics: Biodegradation, Environmental; Naphthalenesulfonates; Spectroscopy, Fourier Transform Infrared; Textiles; Triazines
PubMed: 34881397
DOI: 10.1007/s00203-021-02608-9 -
Veterinary World Sep 2021There is a worldwide controversy about the choice of microbial flora for use as process hygiene indicators. This study aimed to evaluate the pertinence of using either...
BACKGROUND AND AIM
There is a worldwide controversy about the choice of microbial flora for use as process hygiene indicators. This study aimed to evaluate the pertinence of using either coliforms or Enterobacteriaceae (EB) as process hygiene indicators in the pasteurized milk production line. Two flora families and total flora were used as bacterial indicators in some stages of pasteurized milk production line to identify the origin of post-pasteurization contamination and compare the results obtained for each flora. In addition, the bacteriological profile of isolated coliforms and EB was developed.
MATERIALS AND METHODS
One thousand and two hundred samples of pasteurized cow milk and surfaces (pipes and tank) at various processing stages were taken from two dairies in the northern region of Algeria. The total microbial flora (TF), total coliforms (TC), thermotolerant coliforms, and EB were enumerated, following the recommendations of ISO 4833:2006, ISO 4832:2006, and ISO 21528-2:2017 methods, respectively. The bacteriological profile was determined using the API 20E and 10S tests (bioMérieux, France). Furthermore, the cleaning efficiency and disinfection protocol of surfaces were evaluated using contact agar slides 1 (Liofilchem™, Italy).
RESULTS
Enumeration of the different indicators shows that the highest contamination rate is recorded by the total flora in the two units, 3.28 and 3.78 log CFU/mL, respectively. EB (-0.60 log CFU/mL) at post-pasteurization stage in Unit 1 and coliforms (0.44 log CFU/mL) at the pasteurized packaged milk stage in Unit 2 are the least significant germ families. The lowest compliance rates of bacterial contamination were reported for total flora (82-85%) at the three sampled sites in Unit 2. In comparison, the highest was reported in Unit 1 (99.8%) and 2 (98%) by the EB indicator. Assessing the surface cleaning and disinfection protocol compliance shows that the tank records the highest non-compliance rates for EB and TF (4% and 3%) in Unit 2. EB are represented in both units by various species. in Unit 1 and in Unit 2 are the common species of the three indicator families. and in Unit 1, , , , , and in Unit 2 are the most time persistent bacterial genera along the production line. , , and are common genera in both units.
CONCLUSION
The results obtained show no difference in the use of EB or TC as hygiene indicators. However, if the objective is to identify the species of bacterial populations, using EBs are the most appropriate.
PubMed: 34840449
DOI: 10.14202/vetworld.2021.2317-2324 -
Higher abundance of core antimicrobial resistant genes in effluent from wastewater treatment plants.Water Research Jan 2022Wastewater treatment plants (WWTPs) receive sewage water from a variety of sources, including livestock farms, hospitals, industries, and households, that contain...
Wastewater treatment plants (WWTPs) receive sewage water from a variety of sources, including livestock farms, hospitals, industries, and households, that contain antimicrobial resistant bacteria (ARB) and antimicrobial resistant genes (ARGs). Current treatment technologies are unable to completely remove ARB and ARGs, which are eventually released into the aquatic environment. This study focused on the core resistome of urban WWTPs that are persistent through wastewater treatment processes. We adopted the Hiseq-based metagenomic sequencing approach to identify the core resistome, their genetic context, and pathogenic potential of core ARGs in the influent (IN) and effluent (EF) samples of 12 urban WWTPs in South Korea. In this study, the abundance of ARGs ranged from 0.32 to 3.5 copies of ARGs per copy of the 16S rRNA gene, where the IN samples were relatively higher than the EF samples, especially for the macrolide-lincosamide-streptogramin (MLS)- and tetracycline- resistant genes. On the other hand, there were 43 core ARGs sharing up to 90% of the total, among which the relative abundance of sul1, APH(3'')-lb, and RbpA was higher in EF than in IN (p < 0.05). Moreover, tetracycline and sulfonamide-related core ARGs in both EF and IN were significantly more abundant on plasmids than on chromosomes (p < 0.05). We also found that the majority of core ARGs were carried by opportunistic pathogens such as Acinetobacter baumannii, Enterobacter cloacae, and Pseudomonas aeruginosa in both IN and EF. In addition, phages were the only mobile elements whose abundance correlated with that of core ARGs in EF, suggesting that transduction may play a major role in disseminating ARGs in the receiving water environment of the urban WWTP. The persistent release of core ARGs with pathogenic potential into environmental water is of immediate concern. The mobility of ARGs and ARBs in the environment is a major public health concern. These results should be taken into consideration when developing policy to mitigate environmental dissemination of ARG by WWTPs.
Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Genes, Bacterial; RNA, Ribosomal, 16S; Wastewater; Water Purification
PubMed: 34837814
DOI: 10.1016/j.watres.2021.117882