Ahmad M. Ashshi

Paper money and coins as potential vectors of transmissible disease.

Paper currency and coins may be a public health risk when associated with the simultaneous handling of food and could lead to the spread of nosocomial infections. Banknotes recovered from hospitals may be highly contaminated by Staphylococcus aureus. Salmonella species, Escherichia coli and S. aureus are commonly isolated from banknotes from food outlets. Laboratory simulations revealed that methicillin-resistant S. aureus can easily survive on coins, whereas E. coli, Salmonella species and viruses, including human influenza virus, Norovirus, Rhinovirus, hepatitis A virus, and Rotavirus, can be transmitted through hand contact. Large-scale, 16S rRNA, metagenomic studies and culturomics have the capacity to dramatically expand the known diversity of bacteria and viruses on money and fomites. This review summarizes the latest research on the potential of paper currency and coins to serve as sources of pathogenic agents.

Central line associated blood stream infection rate after intervention and comparing outcome with national healthcare safety network and international nosocomial infection control consortium data

Background: Benchmarking of central line associated blood stream infection (CLABSI) rates remains a problem in developing countries due to the variations in surveillance practices and/or infection risk as non-availability of national data. Aim: The aim of the following study was to find out the CLABSI rate before and after central line (CL) bundle intervention and compare the outcome with international surveillance data. Subjects and Methods: This prospective longitudinal cohort study on adult intensive care unit patients was conducted at Hera General Hospital, Makkah Saudi Arabia from January 1 to December 31, 2012. Five key components of bundle were selected; hand hygiene, maximal barrier precautions upon insertion, skin antisepsis, optimum site selection and daily review of line necessity with prompt removal of unnecessary lines. Post-intervention CLABSI rate was compared with National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) rates. Statistical Package for the Social Sciences (SPSS) 14.0 software (SPSS Inc., 233 South Wacker Drive, 11 th floor Chicago, USA) was used for statistical analysis included regression analysis for correlation. Statistical significance was set at P < 0.05. Results: CLABSI rate was reduced from 10.1 to 6.5 per 1000 CL days after interventions and had significant correlation with overall bundle compliance rate 87.6% (P = 0.02) On benchmarking, CLABSI rate after the intervention was similar to mean pool value of INICC (6.8) while higher than NHSN (3.1). The most common microorganisms isolated were; methicillin-resistant Staphylococcus aureus (30.8%), Acinetobacter baumanii (23.3%) and Enterococcus faecalis (15.4%). Conclusion: We found that INICC data was a better benchmarking tool comparative to NHSN because it represents the countries that are developing the surveillance system. A multicenter national study is recommended.

Genetic diversity of the pandemic influenza A (H1N1) virus in Saudi Arabia

INTRODUCTION Pandemic influenza A (H1N1) virus emerged and spread globally in the spring of 2009. Saudi Arabia also witnessed a severe H1N1 pandemic virus epidemic with considerable morbidity and mortality in different parts of the kingdom beginning in June 2009. The influenza A(H1N1)pdm09 virus was detected in samples collected between May 2009 and November 2010 from Makkah region. This study provides data on the viral diagnosis and genetic diversity of hemagglutinin (HA) and neuraminidase (NA) genes of influenza A (H1N1)pdm09 virus from Saudi Arabia. METHODOLOGY Nasopharyngeal swabs from 100 clinically infected patients in the peak of the outbreak were collected from Makkah region and processed for viral diagnosis by viral culture and real-time polymerase chain reaction (PCR). HA and NA genes of 10 selected samples were sequenced and analyzed. RESULTS A total of 100 samples were collected; only 10 samples were found to be positive for influenza A virus infection by real-time PCR. Nucleotide sequence analysis of the HA and NA genes of influenza A (H1N1) from Saudi Arabia showed significant similarities with selected isolates. The phylogenetic tree constructed for both HA and NA genes formed close clusters with selected reference isolates. CONCLUSIONS Nucleotide sequence analysis and phylogenetic relationships of the HA and NA genes of influenza A (H1N1) virus from Saudi Arabia with selected reference isolates indicates that they were genetically close and most probably originated from influenza A(H1N1)pdm09.

Virological diagnosis of dengue fever in Jeddah, Saudi Arabia: Comparison between RT-PCR and virus isolation in cell culture

A total of 233 serum samples were collected from patients presenting to King Abdulaziz University Hospital with suspected cases of Dengue Fever (DF) from 2006 to 2008. Dengue virus was successfully isolated from 70 samples by culture on C6/36 and LLC-MK2 cells; it was then detected by indirect immunofluorescence assay (IFA). The cytopathic effect (CPE) of dengue virus on C6/36 appeared in most of the samples within 1-4 days post-inoculation comparing to 7-12 days on LLC-MK2 cells, and this was characterized by the ability to induce syncytia and multinucleated giant cells. On the other hand, by using RT-PCR technique, 87 (37.3%) samples were positive. All 70 (30.4%) samples with positive cell culture results were detectable by RT-PCR in addition to 17 culture-negative samples were RT-PCR positive. Dengue virus type 1 (DENV-1) was the dominant serotype followed by DENV- 3 and DENV-2, while DENV-4 was not detected in tested samples. These results indicate that DENV-RNA detection by RT-PCR is more sensitive than virus isolation. We suggest that the high sensitivity coupled with the turnaround time, have made the RT-PCR a better choice as a routine test for DENV diagnosis. Key words:

Combinatorial strategies based on CRAd-IL24 and CRAd-ING4 virotherapy with anti-angiogenesis treatment for ovarian cancer

BackgroundA major hurdle incurrent to the human clinical application of conditionally replicative adenovirus (CRAd)-based virotherapy agents is their limited therapeutic efficacy. In this study we evaluated whether arming our previously reported Ad5/3Δ24 CRAd vector containing a 24-base pair deletion in the E1A conserved region 2, which allows selective replication within Rb-p16-deficient tumor cells, to express therapeutic genes could improve oncolytic virus potency in ovarian cancer cells. We choose to assess the therapeutic benefits achieved by virus-mediated expression of interleukin 24 (IL-24), a cytokine-like protein of the IL-10 family, and the inhibitor of growth 4 (ING4) tumor suppressor protein.ResultsThe generated CRAd-IL24 and CRAd-ING4 vectors were tested in ovarian cancer cell lines in vitro to compare their replication, yield, and cytotoxic effects with control CRAd Ad5/3∆24 lacking the therapeutic gene. These studies showed that CRAd-IL24 infection resulted in significantly increased yield of infectious particles, which translated to a marked enhancement of virus-induced cytotoxic effects as compared to CRAd-ING4 and non-armed CRAd. Testing CRAd-IL24 and CRAd-ING4 vectors combined together did not revealed synergistic effects exceeding oncolytic potency of single CRAD-IL24 vector. Both CRAds were also tested along with anti-VEGF monoclonal antibody Avastin and showed no significant augmentation of viral cytolysis by anti-angiogenesis treatment in vitro.ConclusionsOur studies validated that arming with these key immunomodulatory genes was not deleterious to virus-mediated oncolysis. These findings thus, warrant further preclinical studies of CRAd-IL24 tumoricidal efficacy in murine ovarian cancer models to establish its potential utility for the virotherapy of primary and advanced neoplastic diseases.

PP-183 Prevalence of pneumonia cases during the Hajj season

adult. Withdrawal the acute phase serum, we finished the blood routine, hepatic function and IgM antibody test. In adult group we detected the T lymphocytes sub-type using flow cytometry. Results: 216 patients’ infectious spectrum was like a spindle, the infants and adults parts of the infectious spectrum reach a total of 81.48%. The clinical symptoms remain relatively typical. Different groups showed their own clinical manifestations, The major features of the infants group are cough and Korotkoff plaques, in this group, the MV-IgM positive rate is the highest, 83.67% of the infants have complications. The subjects of the children group showed the major symptoms as catarrhal, 70% of which with complications. Hepatic function in the adult group is significantly abnormal. In our 78 cases adult patients, the FCM results suggest CD4 cell count and CD4/CD8 decreased significantly, and CD8 increased significantly, also CD4 + CD45RA + was significantly lower than control (p<0.05), and CD8 + CD45RO + was significantly higher than control group (p<0.05). Conclusion: The use of measles vaccine greatly change its infectious spectrum. The emergence of new clinical characteristics give us challenges for its prevention and control. At the same time, further study of the measles infectious cellular immunity mechanism still needed.