Biography:

Shimaa T. Omara working at National Research Centre, Egypt and she belongs to Department of Microbiology and Immunology.

Abstract:

Staphylococcus aureus is considered the third most common cause of food poisoning worldwide. Milk and milk products are implicated to a large extent in staphylococcal food poisoning. Nowadays, detailed information on the resistance patterns of S. aureus in milk and cheese in the Egyptian market is strongly required to study risk assessment in case of food poisoning context and also to improve therapeutic approaches used in dairy farms. Our objective was to study the phenotypic and genotypic antibiotic resistance features of S. aureus isolated from milk and cheese from the Egyptian market. The multidrug-resistant S. aureus strains were detected in 31(77.5%, 31/40), 6(60%, 6/10), 12(60%, 12/20), 2(20%, 2/10), and 3(12%, 3/25) of raw cattle milk, sheep milk, traditional white cheese, cheddar cheese, and other cheese respectively.  71(67.6%, 71/105) and 67(63.8%, 67/105) of S. aureus strains showed oxacillin and penicillin resistance respectively. S. aureus strains were screened for the presence of mecA, vanA and ermC genes. 78(74.3%, 78/105), 50(47.6%, 50/105) and 38 (36.2%, 38/105) of these strains were carriers for mecA, ermC, vanA genes respectively. High level of MRSA 52(49.5%, 52/105) were detected and it was in details; 31(77.5%, 31/40), 5(50%, 5/10), 10(50%, 10/20), 5(20%, 5/25), and 1(10%, 1/10) within cattle milk, sheep milk, white cheeses, other cheese and cheddar cheese respectively. Out of 41(39.1%, 41/105) phenotypic vancomycin resistant S. aureus strains, 33(31.4%, 33/105) were both phenotypic vancomycin resistant and genotypic vanA gene carrier representing VRSA strains. Out of 48(45.7%, 48/105) isolated phenotypic erythromycin resistant S. aureus strains, 44(42%, 44/105) were ermC gene carrier. The detected mecA, vanA and ermC genes were statistically associated with their encoding phenotypic resistance patterns against penicillin and oxacillin, vancomycin and erythromycin respectively with a P-value ≤0.05 for each of them. Notably for any increase in the rate of mecA, vanA, and/or ermC genes, there was a sharp increase in the resistance rate against penicillin and oxacillin, vancomycin and erythromycin respectively with the OR˃1 for each of them. However, this statistical association wasn’t noticed in any of S. aureus isolated from raw sheep's milk as the P-values was always ˃0.05.

Biography:

Gopika Ambalathara Gopinath completed her MBBS from India and currently she works in the UK. She aspires to become an Emergency Medicine Practitioner in the NHS.

Abstract:

A 36-year-old gentleman presented to the emergency department with a 7 days history of high fever, lethargy and generally unwell. He had no significant past medical history. Physical examination showed he was tachycardiac with temperature of 103 degree Fahrenheit (39 degree Celsius) and systolic BP of 100mm hg. He was slightly icteric with a few palpable groin lymph nodes and a 3cm palpable Liver. Blood tests showed WBC count of 6000 per cubic millimetre or 6*109 cells per litter, liver functions were slightly deranged with a bilirubin of 52 and ALT OF 75u/l. Blood for Malaria parasites, Dengue NS 1 antigen was negative, urine dipstick as negative, chest x ray as normal, ultrasound scan of abdomen revealed enlarged liver. Patient was suspected as having Enteric fever- (Typhoid). He was started treatment with intravenous Ceftriaxone. But patient became more unwell and was transferred to HDU. A further thorough clinical examination revealed a dark scab in the abdomen as shown in the photo below. Patient had further set of blood tests to screen for other tropical infection such as Scrub typhus, Leptospirosis, and it showed positive for scrub typhus IgM antibody scrub typhus. Patient was started on Doxycycline 100mg twice daily and he recovered in a few days.

Discussion
Tropical fevers with organ failure is one of the leading cause of ICU admissions in India. Commonest tropical fevers that leads to organ failure and ICU admission are Malaria, Dengue and Enteric fever. Scrub typhus and Leptospiral disease are less common and are often missed. Scrub typhus is caused by intracellular parasite Orienta tsutsugamushi belonging to rickettsia group, arthropod Tromiculid mite is a vector for this disease. It is endemic in Asia-pacific region being less common in India. Scrub typhus is manifested with fever, headache, myalgia and flu like symptoms, approximately 5-14 days of being bitten by infected trombiculid mite. An eschar at the site of the bite is a classical feature of the disease as shown in the figure. It begins as a papule which ulcerates and then form a dark scar, like a cigarette burn. It is mainly seen in the anterior part of the body. Severe complications include liver failure, acute kidney injury and acute lung injury. Often patients can have severe neurological manifestations such as encephalitis and meningitis. The mortality rate is between 6%-70%. Diagnostic test for scrub typhus includes indirect immunofluorescence test, indirect immune-peroxidase assay, ELISA test, immunochromatographic test. Immunofluorescence test and ELISA test are quick, high specificity (84%-100%) with sensitivity of (70%-100%). Cell culture and antigen detection has high specificity (100%), with low sensitivity (50%) it is time consuming and expensive. Treatment consists of Doxycycline for 10 days. Azithromycin is an alternate drug.

Biography:

Minna Chang is a final year medical student at Imperial College London.

Abstract:

Introduction: M. pneumoniae is a respiratory pathogen, which commonly causes upper and lower respiratory infections. It primarily affects children and young adults. Respiratory symptoms are well recognised, but extra pulmonary involvement is also common. Other systems that have been implicated in the disease include: skin, mucus membranes, central, and peripheral nervous systems, cardiovascular, haematological, renal, musculoskeletal systems. Here, we report a case of an otherwise healthy, young female with M. pneumonia, who presented with right upper quadrant abdominal pain.

Case Presentation: A healthy 25-year-old female was referred to A&E by her general practitioner, after presenting with fever, malaise, and right upper quadrant pain. M. pneumoniae was confirmed retrospectively by serology. The patient made a full recovery after a six-day course of doxycycline 100mg.

Conclusion: M. pneumonia is a well-established cause of respiratory infections in children and young adults. A febrile illness with multisystem involvement, even in the absence of respiratory symptoms, should raise suspicion of M. pneumoniae infection in healthy, young adults. Our case illustrates the multi-system involvement of M. pneumoniae, which was initially missed, due to paucity of respiratory symptoms at presentation.

Biography:

Huang Wei Ling born in Taiwan, raised and graduated in medicine in Brazil, specialist in infectious and parasitic diseases, General Practitioner and Parenteral and Enteral Medical Nutrition Therapist. Once in charge of the Hospital Infection Control Service of the City of Franca’s General Hospital, she was responsible for the control of all prescribed antimicrobial medication and received an award for the best paper presented at the Brazilian Hospital Infection Control Congress (1998). Since 1997, she works with the approach and treatment of all chronic diseases in a holistic way, with treatment guided through teachings of Traditional Chinese Medicine and Hippocrates.

Abstract:

Introduction: Post-polio syndrome (PPS) is characterized by progressive muscle weakness due to former infection with poliomyelitis and is often associated with other symptoms such as muscle fatigue, muscle and or joint pain, cold intolerance (CI) and sleep disorders. Poliomyelitis for TCM is a syndrome of humidity/heat caused by an external factor (virus), initially compromising the gastrointestinal system and causing fever. The external agents responsible for the illness are called “perverse energy”. Once the first layer of defense is broken the virus or “wicked energy” is directed towards the internal organs, specifically the Liver and Kidneys.

Purpose: Demonstrate that polio patients had an energy imbalance and energy deficiency in the chakras that facilitated the development of the disease.

Methods: Through two clinical cases of two female patients one with 42 and the other with 67 years, both presented flaccid paralysis in one of the lower limbs due to post polio syndrome. Both received a measurement of the energy of the chakras which showed complete energy deficiency in all chakras, except for the seventh, which was normal. Chakra energy replacement treatment with homeopathies was started according to the Constitutional Homeopathy of Five elements based on Traditional Chinese Medicine. 

Results: Both patients improved the physical, mental, emotional and pain conditions that they had and continue to be treated today, but there was no change in the flaccid paralysis during the treatment period. 

Conclusion: Both patients in the report had a complete deficiency of the chakras, but the author does not know if at the time of contagion and development of the infectious process, the patients also had this deficiency in the chakras. However, restoring chakra energy in patients with this energy deficiency could be an option for preventing this disease associated with vaccines today.

Biography:

S. Agus presently working at Biophytisin, USA.

Abstract:

Mechanism of Action

SARS-CoV-2 downregulates the protective arm of the renin angiotensin system including its components - ACE2/ Angiotensin 1-7/ Mas receptor. BIO101, a drug candidate with 20-hydroxyecdysone (20E) as the active pharmaceutical ingredient, activates Mas receptor.

Background

In an acute lung injury model, 20E attenuated the level of inflammatory biomarkers. BIO101 was also shown to be protective against muscle function loss in the animal models of ageing, disuse, and Duchenne muscular dystrophy (DMD). In a DMD model, BIO101 ameliorated respiratory function decline. Thus, BIO101 is a promising treatment candidate, for COVID-19 pneumonia.

Method

We report here the COVA trial protocol that aims to investigate safety and efficacy of BIO101 in SARS-CoV-2 pneumonia. COVA is a group sequential, adaptive, phase 2/3 study. Adults ≥45-year-old with confirmed COVID-19 pneumonia requiring hospitalization and with evidence of respiratory decompensation: tachypnea and SpO2 ≤92% are randomized to placebo or BIO101 (350mg BID) for up to 28-day treatment. Part I evaluates BIO101 safety and tolerability (50 participants) and part II proof of efficacy (addition of up to 310 participants).  The primary end point is the proportion of ‘negative’ events: all-cause mortality and respiratory deterioration requiring high-flow oxygen, mechanical ventilation or extracorporeal membrane oxygenation. Sample size and futility assessment will be evaluated halfway through part II during the interim analysis. 

Conclusion

Targeting of Mas receptor makes BIO101 a potential treatment for respiratory failure in COVID-19 pneumonia. Group sequential and adaptive design will allow to reduce the number of exposed participants and the need for repeated studies.