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Microbiologists are increasingly concerned about the rise in S. aureus MLSB (macrolide, lincosamide, streptogramin B) drug resistance. Clindamycin has been effective in treating infections by S. aureus, and the variations in clindamycin sensitivity patterns cause treatment to fail. Inducible clindamycin resistance in S. aureus is expressed via erythromycin ribosome methylase genes. In the current study, 25 S. aureus isolates were identified by conventional chemical tests and the Vitek®2 system. Specific primers were used for the amplification of Macrolide genes by PCR. Among 25 S. aureus isolates, 23(92%) isolates were methicillin resistant and 2(8%) isolates were methicilin sensitive. The 5(20%) isolates showed resistance to Erythromycin and sensitivity to Clindamycin with a positive D test which was identified as inducible MLSB, while 2(8%) isolates showed resistance criteria for both Erythromycin and Clindamycin which identity as a constitutive MLSB and 18(92%) isolates were given the sensitivity for both Erythromycin and Clindamycin. The erm resistance genes (ermA, ermB, ermC, ermF, and ermG) were detected in 5(20%), 17(68%), 25(100%), 24(96%),11(44%) respectively. The D-test, and Vitek ®2 system should be routinely done to avoid treatment failure due to clindamycin resistance.

Thrombotic thrombocytopenia syndrome (TTS) events were reported very rarely following the coronavirus disease 2019 (COVID-19) vaccine AstraZeneca (Vaxzevria). Clinical and demographic characteristics of the affected people, including the outcomes of TTS events, need to be examined using available information to better understand aspects of this association.To analyse clinical and demographic information of TTS events, including calculating the case fatality of reported cases of TTS by age and sex, using spontaneously reported data from the UK's Yellow Card spontaneous reporting system of suspected adverse drug reactions.TTS events reported to the Yellow Card scheme were extracted at weekly time points between 12 May 2021 and 25 May 2022. Cumulative numbers of TTS cases and deaths were recorded for each weekly interval, overall and stratified by age, sex, and vaccine dose.To 25 May 2022, 443 cases (81 fatal, 18.28%) had been reported in the UK. Events more frequently occurred following the first vaccine dose. No trends were observed for case fatality overall, or by age or sex.In the UK, case fatality of TTS events reported to the Medicines and Health products Regulatory Agency (MHRA) following Vaxzevria has been approximately 17-18% since May 2021. There were no statistical differences in fatality based on age or sex. Most reports followed the first vaccine dose; none have been reported following a third dose to date, although Vaxzervia was not recommended for a third dose of COVID-19 vaccine in the UK. TTS remains very rare, and benefits of vaccination outweigh the risks.

The focus of this article is to add a new class of rank one of modified Quasi-Newton techniques to solve the problem of unconstrained optimization by updating the inverse Hessian matrix with an update of rank 1, where a diagonal matrix is the first component of the next inverse Hessian approximation, The inverse Hessian matrix is generated by the method proposed which is symmetric and it satisfies the condition of modified quasi-Newton, so the global convergence is retained. In addition, it is positive definite that guarantees the existence of the minimizer at every iteration of the objective function. We use the program MATLAB to solve an algorithm function to introduce the feasibility of the proposed procedure. Various numerical examples are given`.

Allopurinol is a urate-lowering therapy used to treat patients with gout. Previous studies have shown that allopurinol has positive effects on several cardiovascular parameters. The ALL-HEART study aimed to determine whether allopurinol therapy improves major cardiovascular outcomes in patients with ischaemic heart disease.ALL-HEART was a multicentre, prospective, randomised, open-label, blinded-endpoint trial done in 18 regional centres in England and Scotland, with patients recruited from 424 primary care practices. Eligible patients were aged 60 years or older, with ischaemic heart disease but no history of gout. Participants were randomly assigned (1:1), using a central web-based randomisation system accessed via a web-based application or an interactive voice response system, to receive oral allopurinol up-titrated to a dose of 600 mg daily (300 mg daily in participants with moderate renal impairment at baseline) or to continue usual care. The primary outcome was the composite cardiovascular endpoint of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. The hazard ratio (allopurinol vs usual care) in a Cox proportional hazards model was assessed for superiority in a modified intention-to-treat analysis (excluding randomly assigned patients later found to have met one of the exclusion criteria). The safety analysis population included all patients in the modified intention-to-treat usual care group and those who took at least one dose of randomised medication in the allopurinol group. This study is registered with the EU Clinical Trials Register, EudraCT 2013-003559-39, and ISRCTN, ISRCTN32017426.Between Feb 7, 2014, and Oct 2, 2017, 5937 participants were enrolled and then randomly assigned to receive allopurinol or usual care. After exclusion of 216 patients after randomisation, 5721 participants (mean age 72·0 years [SD 6·8], 4321 [75·5%] males, and 5676 [99·2%] white) were included in the modified intention-to-treat population, with 2853 in the allopurinol group and 2868 in the usual care group. Mean follow-up time in the study was 4·8 years (1·5). There was no evidence of a difference between the randomised treatment groups in the rates of the primary endpoint. 314 (11·0%) participants in the allopurinol group (2·47 events per 100 patient-years) and 325 (11·3%) in the usual care group (2·37 events per 100 patient-years) had a primary endpoint (hazard ratio [HR] 1·04 [95% CI 0·89-1·21], p=0·65). 288 (10·1%) participants in the allopurinol group and 303 (10·6%) participants in the usual care group died from any cause (HR 1·02 [95% CI 0·87-1·20], p=0·77).In this large, randomised clinical trial in patients aged 60 years or older with ischaemic heart disease but no history of gout, there was no difference in the primary outcome of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death between participants randomised to allopurinol therapy and those randomised to usual care.UK National Institute for Health and Care Research.

In this study, twenty two pure bacterial strains isolates were isolated that can use crude oil as a carbon source. They occured at different frequency ratios for each of oil-contaminated soil samples, the produced water, and the crude oil of the Al-Rafidiyah oil field (Basrah south of Iraq). Bacterial isolates were characterized and identified based on phenotypic properties and molecular techniques. Fourteen strains, belonging to three genera of Bacillus sp., Lysinibacillus sp. and Enterobacter sp., were isolated from oil-contaminated soil and nine strains, belonging to Bacillus sp., Lysinibacillus sp., Enterobacter sp. and Brevibacillus sp., were isolated from produced water. Five strains, belonging to two genera, Bacillus sp. and Pseudomonas sp., were isolated from crude oil. New twelve strains were recorded as new strains and deposited in GenBank include Bacillus cereus strain ASWISA1, Bacillus thuringiensis strain ASWISA2, Bacillus sonorensis strain ASWISA3, Bacillus cereus strain ASWISA4, Bacillus subtilis strain ASWISA5, Pseudomonas stutzeri strain ASWISA6, Bacillus subtilis strain ASWISA7, Bacillus cereus strain ASWISA8, Bacillus paramycoides strain ASWISA9, Bacillus paramycoides strain ASWISA10, Brevibacillus brevis strain ASWISA11, and Enterobacter cloacae strain ASWISA12.

ObjectivesTo combine spontaneously reported data from multiple countries to estimate reporting rate, and better understand risk factors for myocarditis and pericarditis following COVID-19 messenger RNA (mRNA) vaccines.DesignSystematic review of spontaneously reported data from UK, USA and European Union/European Economic Area (EU/EEA) and of the scientific literature.Data sourcesUK Yellow Card scheme, Vaccine Adverse Event Reporting System (VAERS), EudraVigilance were searched from date of vaccine launch to 14 March 2022–16 March 2022. PubMed/MEDLINE and Embase were searched to 15 March 2022.Eligibility criteriaWe included publicly available spontaneous reporting data for ‘Myocarditis’ and ‘Pericarditis’ from UK, USA and EU/EEA following COVID-19 mRNA vaccines. Pharmacoepidemiological observational studies investigating myocarditis/pericarditis following mRNA COVID-19 vaccines were included (no restrictions on language or date). Critical Appraisal Skills Programme tools assessed study quality.Data extraction and synthesisTwo researchers extracted data. Events of myocarditis and pericarditis were presented for each data source, stratified by vaccine, age, sex and dose (where available). Reporting rates were calculated for myocarditis and pericarditis for each population. For published pharmacoepidemiological studies, design, participant characteristics, and study results were tabulated.ResultsOverall, 18 204 myocarditis and pericarditis events were submitted to the UK, USA and EU/EEA regulators during the study period. Males represented 62.24% (n=11 331) of myocarditis and pericarditis reports. In the UK and USA, most reports concerned vaccinees aged ConclusionsYounger vaccinees more frequently report myocarditis and pericarditis following mRNA COVID-19 vaccines than older vaccinees. Results from published literature supported the results of our analyses.

BACKGROUND: Antibiotics called macrolide, lincosamide and streptogramin B (MLS(B)) are being used to treat staphylococci infections. Multiple pathways that impart resistance to MLS(B) antibiotics have been confirmed to cause clinical failure. The present work aimed to determine the frequency of constitutive and inducible clindamycin resistant among coagulase-negative staphylococci (CoNS) isolates of different clinical samples in Al-Basrah governorate, Iraq. METHODS: The 28 CoNS, traditional techniques and the Vitek®2 system were used to identify the isolates. The disk diffusion technique was used to detect methicillin resistance and antibiotic sensitivity patterns via cefoxitin, gentamicin, ciprofloxacin, amikacin, teicoplanin, linezolid, doxycycline and vancomycin disks. Erythromycin and clindamycin antibiotic disks was used to detect the inducible and constitutive clindamycin resistance as well as a D-test according to CLSI guidelines. RESULTS: Among 28 CoNS isolated, the Staphylococcus aureus 11(39.29%), Staphylococcus epidermidis 7(25 %), Staphylococcus haemolyticus 4(14.29%) and Staphylococcus saprophyticus 3 (10.71%) were predominant isolated species. Out of 28 CoNS isolates, 15(53.57%) were methicillin resistant coagulase-negative staphylococci (MRCoNS) isolates and 13(46.43%) were methicillin sensitive coagulase-negative staphylococci (MSCoNS) isolates. The 15(53.57%) isolates out of 28 CoNS, showed erythromycin resistance while 6(40%) isolates out of 15 CoNS, showed inducible macrolide-lincosamide-streptogramin B (iMLS(B)) and 2(13.3%) of CONS isolated showed constitutive macrolide-lincosamide-streptogramin B (cMLS(B)). CONCLUSION: In order to achive the best result in choosing the suitable treatment and avoiding the loses the money and time, it is better to use the D-test for inducible clindamycin resistance in the daily routine work of antibiotic susceptibility testing in hospital and private clinical laboratories.

ObjectivesTo determine whether spontaneous reporting rates of myocarditis and pericarditis differed in immunocompromised patients compared to the whole population overall, and in terms of demographics, vaccine dose, and time-to-onset.DesignSystematic review of spontaneously reported data from the European Union/European Economic Area (EU/EEA), the United States (US) and the United Kingdom (UK).Data SourcesEudraVigilance (EU/EEA), Vaccine Adverse Event Reporting System (VAERS; US) and the Medicines and Healthcare products Regulatory Agency (MRHA, UK) spontaneous reporting databases were searched from date of vaccine launch to 01 December 2021.Eligibility criteriaPublicly available spontaneous reporting data for “Myocarditis” and “Pericarditis” from EU/EEA and US following COVID-19 mRNA vaccines. Reports with comorbidities or concurrent medication indicative of transplantation, HIV infection, or cancer (“immunocompromised” population) were compared with each overall database population.Data extraction and synthesisTwo researchers extracted data. Spontaneously reported events of myocarditis and pericarditis were presented for immunocompromised populations for each data source, stratified by age, sex, dose, and time-to-onset (where available). Seriousness of each event was determined according to the ICH E2A definition. Proportional Reporting Ratio (PRR) was calculated.ResultsThere were 178 reports of myocarditis and pericarditis amongst immunocompromised individuals overall. Seriousness was comparable between the immunocompromised and overall populations in both databases. No trends in age or sex were observed amongst immunocompromised individuals. Most reports followed a second vaccine dose and occurred within 14 days. The frequency of reporting was similar to the wider population (PRR=1.36 [95% CI= 0.89-1.82] for VAERS population).ConclusionsMyocarditis and pericarditis following COVID-19 vaccination are very rare, and benefits of COVID-19 vaccination continue to outweigh any perceived risks. Reporting rates of myocarditis and pericarditis were similar in immunocompromised individuals, however defining characteristics differed compared to the whole population; therefore, continued monitoring of adverse events following vaccination remains vital to understand differences between population subgroups.Strengths and Limitations of the StudyThis is the first study to bring together spontaneous reporting data from three regions (Europe, the United States, and the United Kingdom) comparing immunocompromised and immunocompetent populations adverse reactions following COVID-19 mRNA vaccinationSpontaneously reported adverse drug reaction data is known to be subject to underreporting and missing information, including information on comorbidities and concomitant medications.Further biases that may have influenced results, include differences in vaccination strategies between the three regions examined, differences in data collected via spontaneous reporting systems, and the fact that serious events are more likely to be reported.It is not possible to estimate incidence rates using spontaneous reporting data due to a lack of precise denominator data, i.e. the number of people who received the vaccine in the corresponding period.

ObjectivesTo bring together spontaneously reported data from multiple countries to estimate reporting rate, and better understand risk factors for myocarditis and pericarditis following COVID-19 mRNA vaccines.DesignSystematic review of spontaneously reported data from United Kingdom (UK), United States (US), and European Union/European Economic Area (EU/EEA) and of the literature.Data sourcesUK Yellow Card scheme, Vaccine Adverse Event Reporting System (VAERS), EudraVigilance were searched from date of vaccine launch to 14-16 March 2022. PubMed/MEDLINE and Embase were searched to 15 March 2022.Eligibility criteriaWe included publicly available spontaneous reporting data for “Myocarditis” and “Pericarditis” from UK, US, and EU/EEA following COVID-19 mRNA vaccines. Pharmacoepidemiological observational studies investigating myocarditis/pericarditis following mRNA COVID-19 vaccines were included (no restrictions on language or date). Critical Appraisal Skills Programme (CASP) tools assessed study quality.Data extraction and synthesisTwo researchers extracted data. Spontaneously reported events of myocarditis and pericarditis were presented for each data source, stratified by vaccine, age, sex, and dose (where available). Reporting rates were calculated for myocarditis and pericarditis for each population. For published pharmacoepidemiological studies, design, participant characteristics, and study results were tabulated.ResultsOverall, 18,204 myocarditis and pericarditis events have been submitted to the UK, US, and EU/EEA regulators during the study period. Males represented 62.24% (n=11,331) of myocarditis and pericarditis reports. Most reports concerned vaccinees aged ConclusionsYounger vaccinees more frequently report myocarditis and pericarditis following mRNA COVID-19 vaccines than older vaccinees. Results from published literature supported the results of our analyses.Strengths and Limitations of the StudyThis is the first study to bring together spontaneously reported data from the United Kingdom, United States, and Europe on myocarditis and pericarditis following mRNA COVID-19 vaccines.Results from this study provide evidence on the frequency of reported events of myocarditis and pericarditis following mRNA vaccines in different age groups, and by sex and vaccine dose; analyses of spontaneous reports were consolidated with results of published literature, identified by systematic review.Results may have been influenced by biases including different vaccination policies in each region examined, and publicity on events of myocarditis and pericarditis following mRNA vaccines.The study relied on outputs from spontaneous reporting systems in which the level of detail differed between the systems examined; furthermore, it is not possible to estimate incidence rates using spontaneous reports due to the lack of data on the exposed population, and there is no unvaccinated comparison group.There is an urgent need for further pharmacoepidemiological studies to be conducted to provide more accurate estimates of the frequency, clinical course, long term outcome, effects of treatment and impact on quality of life, to address many of the limitations of spontaneous reporting.

The objective of this article is to solve the unconstrained optimization problem by using Marquardt method together with MQ-N (modified quasi-Newton) method. The Hessian matrix will be computed numerically by using modified Broyden-Flechert-Goldfarb-Shanno (BFGS) update ( H-version) after convert it to the B-version by using Sherman-Morisson-Woodburge (SMW) formula which guarantee the two important properties SPD (symmetric and positive definite), and hence the exact second derivative of OF (objective function) does not be needed to compute. The line search technique is very important to accelerate the method to terminate at the minimum value of OF, so in this article the line search technique is instead by used the search technique of Marquardt method together with MQ-N method (especially modified BFGS method where the step size is equal one) to solve the unconstrained optimization problem. Test problems are solved by Matlab software to prove the effective of this new technique so called the Marquardt extended technique (MET).

The aim of this paper is to introduce the new class of Broyden convex update by using modified symmetric rank1 update together with modified BFGS update for inverse of hessian matrix where the parameter in used is Hoshino parameter, numerical examples are solved and introduce the convergence of the proposed class and the results are reported as a table of computation.

Objectives: The aim of this analysis was to investigate the effect of the treatment guidelines on case fatality of the event of thrombosis with thrombocytopenia following COVID-19 AstraZeneca vaccination in the UK. Objectives were to produce estimates for weekly case fatality overall, and by sex, age, and vaccine dose. Setting: Publicly available reports to the UK’s Yellow Card spontaneous reporting system at weekly time points between 12 May 2021 and 30 June 2021. Main outcome measures: Cumulative and incident numbers of TTS cases and deaths were recorded for each weekly interval, overall and stratified by age, sex, and vaccine dose. Results: Up to 30 June 2021, 399 cases (71 fatal; 17.79%) had been reported to the Yellow Card scheme. To the same date, more than 24 million first doses and 21 million second doses of the vaccine had been administered in the UK. Events more frequently occurred following the first dose of COVID-19 Vaccine AstraZeneca compared with the second dose. No trends were observed for weekly case fatality overall, or by age or sex. Conclusions: Evidence from spontaneously reported data in the UK does not suggest an improvement in the prognosis in terms of a fatal outcome for TTS at this stage of the vaccination programme, despite the comprehensive treatment protocol for patients with TTS following the COVID-19 AstraZeneca vaccine in the UK.