The Rapidly Changing Patterns in Bacterial Co-Infections Reveal Peaks in Limited Gram Negatives during COVID-19 and Their Sharp Drop Post-Vaccination, Implying Potential Evolution of Co-Protection during Vaccine-Virus-Bacterial Interplay

SARS-CoV-2 has caused the most devastating pandemic of all time in recent human history. However, there is a serious paucity of high-quality data on aggravating factors and mechanisms of co-infection. This study aimed to identify the trending patterns of bacterial co-infections and types and associated outcomes in three phases of the pandemic. Using quality hospital data, we have investigated the SARS-CoV-2 fatality rates, profiles, and types of bacterial co-infections before, during, and after COVID-19 vaccination. Out of 389 isolates used in different aspects, 298 were examined before and during the pandemic (n = 149 before, n = 149 during). In this group, death rates were 32% during compared to only 7.4% before the pandemic with significant association (p-value = 0.000000075). However, the death rate was 34% in co-infected (n = 170) compared to non-co-infected patients (n = 128), indicating a highly significant value (p-value = 0.00000000000088). However, analysis of patients without other serious respiratory problems (n = 28) indicated that among the remaining 270 patients, death occurred in 30% of co-infected patients (n = 150) and only 0.8% of non-co-infected (n = 120) with a high significant p-value = 0.00000000076. The trending patterns of co-infections before, during, and after vaccination showed a significant decline in Staphylococcus aureus with concomitant peaks in Gram negatives n = 149 before/n = 149 during, including Klebsiella pneumonian = 11/49 before/during, E. coli n = 10/24, A. baumannii n = 8/25, Ps. aeruginosa n = 5/16, and S. aureus 13/1. Nevertheless, in the post-vaccination phase (n = 91), gender-specific co-infections were examined for potential differences in susceptibility. Methicillin-resistant S. aureus dominated both genders followed by E. coli in males and females, with the latter gender showing higher rates of isolations in both species. Klebsiella pneumoniae declined to third place in male patients. The drastic decline in K. pneumoniae and Gram negatives post-vaccination strongly implied a potential co-protection in vaccines. Future analysis would gain more insights into molecular mimicry.

The Extent of the Use of Multivitamins and Multimineral Supplements Without Clinically Measurable Benefits Among Adults in Ha'il, Saudi Arabia: A Cross-Sectional Study

Introduction Multivitamins and multiminerals (MVMM) are nutritional supplements that contain a wide range of important nutrients. The use of vitamins and minerals has been showing a tremendous increase over the past few years due to the high demand for supplements to replenish nutritional deficiencies. Purpose This study aimed to assess MVMM usage, the reasons why people chose to use MVMM, and the factors related to this usage. Methodology A cross-sectional study was conducted on adults living in Ha'il, Saudi Arabia. Data were collected between October 31 and December 14, 2022, a self-administered online questionnaire was used, and data were analyzed using SPSS version 25.0 (IBM Corp, Armonk, NY). Results A total of 310 participants enrolled in the study, of which 240 (77.42%) were females and 70 (22.58%) were males. The extent of the use of MVMM supplements without clinically measurable benefits was more than half of the present study participants (58.71%). There was a significant difference between MVMM use and gender or employment status. MVMM usage on a regular basis was found to be associated with satisfaction with the outcomes. The majority of participants used MVMM to promote health. Calcium and vitamin D were found to be the most common types of dietary supplements used. Conclusion The use of MVMM supplements without clinically measurable benefits was more prevalent among females. It is important to promote public health awareness programs about the benefits and risks of overdose.

Persistence of COVID-19 symptoms beyond 3 months and the delayed return to the usual state of health in Saudi Arabia: A cross-sectional study

A substantial number of COVID-19 survivors describe ongoing symptoms long after the acute phase. This so-called post-COVID-19 syndrome or long COVID occurs irrespective of initial disease severity.

A Multi-Point Surveillance for Antimicrobial Resistance Profiles among Clinical Isolates of Gram-Negative Bacteria Recovered from Major Ha'il Hospitals, Saudi Arabia

The devastating nosocomial resistance is an on-going global concern. Surveillance of resistance is crucial for efficient patient care. This study was aimed to conduct a surveillance in four major Ha'il Hospitals from September to December 2020. Using a multipoint program, records of 621 non-duplicate Gram-negative cultures were tested across 21 drugs belonging to different categories. Major species were Klebsiella pneumoniae (n = 187, 30%), E. coli (n = 151, 24.5%), Pseudomonas aeruginosa, (n = 84, 13.6%), Acinetobacter baumannii (n = 82, 13.3%), and Proteus mirabilis (n = 46, 7%). Based on recent resistance classifications, A. baumanni, P. aeruginosa, and enteric bacteria were defined as pan-resistant, extremely resistant, and multi-drug resistant, respectively. A. baumannii (35%) and K. pneumoniae (23%) dominated among coinfections in SARS-CoV2 patients. The "other Gram-negative bacteria" (n = 77, 12.5%) from diverse sources showed unique species-specific resistance patterns, while sharing a common Gram-negative resistance profile. Among these, Providencia stuartii was reported for the first time in Ha'il. In addition, specimen source, age, and gender differences played significant roles in susceptibility. Overall infection rates were 30% in ICU, 17.5% in medical wards, and 13.5% in COVID-19 zones, mostly in male (59%) senior (54%) patients. In ICU, infections were caused by P. mirabilis (52%), A. baumannii (49%), P. aeruginosa (41%), K. pneumoniae (24%), and E. coli (21%), and most of the respiratory infections were caused by carbapenem-resistant A. baumannii and K. pneumoniae and UTI by K. pneumoniae and E. coli. While impressive IC, hospital performances, and alternative treatment options still exist, the spread of resistant Gram-negative bacteria is concerning especially in geriatric patients. The high selective SARS-CoV2 coinfection by A. baumannii and K. pneumoniae, unlike the low global rates, warrants further vertical studies. Attributes of resistances are multifactorial in Saudi Arabia because of its global partnership as the largest economic and pilgrimage hub with close social and cultural ties in the region, especially during conflicts and political unrests. However, introduction of advanced inter-laboratory networks for genome-based surveillances is expected to reduce nosocomial resistances.

Willingness to Test for COVID-19: A Cross-Sectional Study on the Population in the Ha’il Region, KSA

Aims: To measure the degree to which the Ha’il community is willing to test for COVID-19 and assess the possible factors that may influence their decision. Study Design: Descriptive and analytical cross-sectional study. Place and Duration of Study: The study was conducted in Ḥaʼil Community. And the data was collected from October to November of 2020. Methodology: Participants comprised of both Saudi and non-Saudi males and females who were 18 years or older and living within the Ha’il region. Participants were recruited via convenience sampling by distributing the electronic questionnaire throughout various social media platforms. Results: Of the 664 participants, 80.9% reported their willingness to test for COVID-19 if they had olfactory dysfunction with, 80.3% reporting their willingness to test if they had difficulty breathing. However, only 61.7% of participants said that they would be willing to be tested if they had been in contact with someone who had tested positive, whilst they themselves were asymptomatic. More than half of the participants reported that they were confident in the results (81%). Bio-demographic factors that influence the degree of public trust were as follows; females (83.8%); living with others (81.8%); history of not gathering with more than 10 people outside their household (87.9%). Conclusion: Our finding revealed that the vast majority of the Ha’il community are willing to test for COVID-19, with a high proportion of females, participants who are living with others and participants who do not usually mix with more than 10 people at the same time showing a greater degree of trust in the results of the COVID-19 test. Furthermore, when participants had experienced olfactory dysfunction or\and breathing difficulties themselves, they tended to exhibit greater trust in the COVID-19 test results.

Assessment of perception of medical students in regard to links between tobacco or alcohol use and cancer

BACKGROUND

The aim of this study was to assess cancer awareness among medical students in Saudi Arabia toward tobacco and alcohol use as risk factors.

MATERIALS AND METHODS

A cross-sectional survey from October to December 2014, covering 1200 medical students, was performed.

RESULTS

Of the total, 975 (81.25%) responded. The male to female ratio was 1.00:7.125. 96/975 (9.8%) had smoked tobacco in their lifetime, and 51/975 (5.23%) were alcoholic beverage consumers. On asking them whether tobacco smoking and alcohol consumption can cause cancer, only 4/975 (0.4%) and 14/975 (1.43%) answered no for smoking and alcohol, respectively.

CONCLUSIONS

The prevalence of smoking and alcohol use is very low among medical students, which might be due to high female contribution besides social stigma. The prevalence of second-hand smoke (SHS) was found to be very high in Hail region.

The use of ELISA and immunohistochemistry techniques for detection of Toxoplasma gondii antigen in tissues of experimentally infected mice

The capability of double antibody sandwich enzyme-linked immunosorbent assay (ELISA) for detecting antigens of Toxoplasma gondii (T. gondii) in different mice tissue specimens was evaluated in comparison to the immunohistochemistry (IHC) technique. Results proved that tissue antigens were detectable in liver, kidney and mesenteric lymph node (LN) specimens by both methods from the second day of infection, with statistically significant increase in its amount in all organs throughout the period of the study. Using ELISA technique, the highest antigen level was recorded on the second day (0.120+/-0.0015) and the fourth day (0.147+/-0.0034) of infection in LN specimens, while, the liver showed the highest antigen level at the sixth day post infection (PI)(0.165+/-0.0066). On the other hand, using the IHC technique, the highest number of tachyzoites was recorded in LN sections in all studied durations, the second, the fourth and the sixth days PI (1.1+/-0.875, 1.6+/-1.173 & 3.1+/-1.370 respectively). Thus, sandwich ELISA technique might offer a valuable aid for rapid diagnosis of acute toxoplasmosis in human tissues, and it has proved to be more accurate than IHC technique, since its results was coincided with the pathogenesis of the disease.

Diagnosis of Blastocystis hominis by different staining techniques

One hundred and fifty stool samples were collected from diarrheic patients of different ages, and examined for Blastocystis hominis by direct smears and concentrated by Sheather's sugar flotation. Staining was done by: Giemsa, two modifications of trichrome stain, modified Ziehl-Neelsen, safranin-methylene blue and two-auramine stains. Out of the 150 cases nine were positive for blastocystosis. The best stains were safranin-methylene blue and modified Ziehl-Neelsen stains. They had the advantage of staining cysts and amoeboid forms besides being rapid and easy to perform. The modified trichrome stains identified 8 ie, less specific and were time consuming. The auramine dyes stained the cyst, both the wall and internal body fluoresced brightly. Giemsa stain was not an efficient stain. Scanning and transmission electron microscopy (SEM, TEM) were performed to study the fine ultrastructure.

Urinary antigen detection for diagnosis of hydatid disease

Hydatid antigen was demonstrated for the first time in urine of patients with hydatidosis by coagglutination test (Co-A). Urinary antigen was detected in all Co-A positive serum corresponding samples of surgically confirmed hydatid disease. The sensitivity and specificity were 100% in urine compared with the corresponding serum samples. These results clarified that the use of Co-A test for detection of hydatid antigen in urine is an easy, simple, rapid, non-invasive and efficient method for diagnosis of hydatidosis.

Genetical and electron microscopical studies on Cryptosporidia

The present work was to clarify whether C. parvum oocysts have different strains in human patients by using different staining, electron microscopical and genetical techniques. A trial to induce a vaccine against Cryptosporidial infection in mice was carried out using killed autoclaved Cryptosporidial oocysts. The results obtained were satisfactory. Two genotypes of C. parvum, viz: human and zoonotic genotypes were detected and described. The killed vaccine used orally gave a promising results.

In-pouch TV culture system in diagnosis of Trichomonas vaginalis infection

A newly simplified culture method, the In-Pouch TV culture system, the wet mount (WM) examination and the acridine orange stain were compared with the Oxoid culture as a standard technique in the diagnosis of trichomoniasis. Out of 70 symptomatic cases enrolled in this study, 28 specimens were positive by all methods. Among these positive specimens, 21 were positive by the Oxoid culture (75%) and 24 (85.7%) with sensitivity of 85.7% by the In-Pouch system. Both wet mount preparation and acridine orange stain had less sensitivity than the In-Pouch system (61.9%) and detected 15 (53.6%) and 16 (57.1%) of the cases respectively. The In-Pouch system has been proved to be easier in the transport and culture technique than the ordinary culture method. It alleviates the need to enter the culture, thus prevents contamination. Its cost is comparable to the ordinary culture tube. Therefore, it is recommended to use the In-Pouch culture system as a method of diagnosing trichomoniasis.

Effect of ozone on the viability of some protozoa in drinking water

Water samples from household tanks in several districts of Alexandria, were examined for protozoa contamination and study to the effect of ozone and chlorine on their viability. The parasitic protozoa encountered were Giardia (56%), Cryptosporidia (50%), Blastocystis (12%), Cyclospora (9%) and Microsporidia (3%). Distilled water was treated by ozone or chlorine. Ozonated-water samples were prepared at a concentration of 1 ppm after contact times with ozone of three, five, seven and nine minutes. Chlorine concentrations were 4 and 8 ppm. Parasites were incubated overnight at room temperature with the treated distilled water. Viability of the parasites was assessed by examining intestinal sections of infected animals. The best results were obtained by using ozonated water after a contact time of nine minutes. Giardia, Cryptosporidia and Microsporidia were completely inactivated, while infectivity of Cyclospora and Blastocystis was markedly reduced. It is suggested that ozone at an appropriate concentration inactivate pathogenic protozoa in water.

A comparison between human, crustacean and bivalve isolates of Microsporidia

Identification of Microsporidia detected in diarrhoeic stool of human and from press preparation of crabs, and bivalves muscles was done by staining with Giemsa, modified trichrome and H & E stains respectively. Positive samples were isolated & used for infection of 3 groups of mice viz group A human isolate, group B crab & group C bivalve isolates. Parasitological and histopathological studies using light and transmission electron microscopy (TEM) were done for samples from each group. The results clarified that human, crab & bivalve Microsporidia isolates showed common features. They were found in the supranuclear region of enterocytes. The stages observed were meronts, sporonts and free spores. Each spore was 1-2 um in length containing a single nucleus, a vacuole and a polar filament. Further genetical and biochemical studies will be undertaken to confirm the similarity or differences between these isolates.

Coccidial infection in immunosuppressed mice: prophylaxis and treatment with dehydroepiandrosterone

Cryptosporidiosis and toxoplasmosis are diseases caused by opportunistic coccidial parasites that can lead to life-threatening infection in immunocompromised patients. We evaluated dehydroepiandrosterone as prophylaxis and therapy in immunosuppressed mice infected with Cryptosporidium parvum and avirulent Toxoplasma gondii. Mice were infected with either Cryptosporidium oocysts or Toxoplasma cysts. Assessment was by mortality rates, parasitic counts and electron microscopic studies. Mortality rates were significantly reduced in all treated groups. A significant reduction in the cryptosporidial oocyst count in stool and intestinal villi and in Toxoplasma cysts in the brains of infected mice was observed in all the groups. The effect of the drug was greater when given prior to infection.

Detection of Cryptosporidium parvum antigen by co-agglutination test and ELISA

Confirmation of the presence of Cryptosporidium in environmental samples is laborious, costly and often difficult. We report here a simple and economic slide agglutination test (co-agglutination test) for detecting cryptosporidial antigen in stool, serum and water. The results show that as a screening method co-agglutination is clearly superior to enzyme-linked immunosorbent assay (ELISA) and modified Ziehl-Neelsen staining, although ELISA is more accurate. The co-agglutination test is recommended for application as a new tool for detecting cryptosporidial antigen in large-scale epidemiological surveys.

Electroencephalographic changes in rats received antigens of different parasites

The prevalence of epilepsy in developing countries is much higher than in developed ones. Some of the highest prevalence rates in developing countries have been reported from tropical Africa where parasitic infections are endemic. This work was carried out to assess the effect of different parasitic antigens on the activity of cerebral cortex in rats. Nine crude antigens were used: Adult Fasciola, adult S. mansoni, hydatid cyst, T. spiralis, E. histolytica, Acanthamoeba spp. G. lamblia, Cryptosporidium spp. and crude antigen of T. gondii. All the parasitic antigens induced electroencephalographic changes compared with baseline tracings.

Detection of Cryptosporidia in different water sources in Alexandria by monoclonal antibody test and modified Ziehl Neelsen stain

Cryptosporidium paruum has become one of the most important contaminant found in drinking water and is associated with high risk of waterborne diseases particularly for the immunocompromised. In the present study, Cryptosporidium was found in uncovered water tanks, nearby the shore in El Noubareya and El Mahmoudeya canals and in one swimming pool. Direct flourescence monoclonal antibody was more sensitive in detecting the organism. Ziehl-Neelsen although less sensitive, yet it has the advantage that it could recognize other protozoa causing diarrhoea as G. lamblia, B hominis and Cyclospora sp.

Aminosidine sulphate in experimental giardiasis

Giardia lamblia infection may be asymptomatic or may produce diarrhea with or without malabsorption. Many drugs were used for treatment of giardiasis, but none proved to be ideal since all have potential troublesome side effects as they are absorbed from the intestine. In this study, a locally acting drug aminosidine-sulphate (gabbroral) has been tried in treatment of experimental giardiasis in a rat model under different conditions of gastric acidity which is one of the main local factors affecting the pathogenicity of the organism. The best results were obtained in the group with hyperacidity which was induced by indomethacin (indocid) with significant improvement in the pathological picture and parasitic count. While in experimental animals with normal acidity there was only partial eradication of the parasite. However, in the group with hypoacidity induced by cimetidine (cimetex), the drug showed no beneficial effects since most organisms invaded the deeper layers of the intestine escaping the local action of the drug.

Aminosidine sulphate in experimental cryptosporidiosis

The present study aimed at investigating the efficiency of a recent antibiotic Aminosidine sulphate (Gabbroral) in experimental cryptosporidiosis. The course of infection was studied when the drug was given early before the infection, and late during the infection both parasitologically and histopathologically. When the drug was given early, the results were satisfactory, with a significant reduction of size, number and pathological changes of the parasites in the stool and in ileal sections of infected mice. However, the drug had no effect when given late during the infection.

A study on experimental cryptosporidiosis

Cryptosporidium oocysts were isolated from stools of infected patients diagnosed as cryptosporidiosis. Suckling Swiss albino mice were infected orally by these oocysts in a dose of 10(6) oocysts/mouse. Mice were divided into 9 groups according to the duration of infection 2, 3, 4, 5, 6, 7, 10, 10, 15, 21 days postinfection, corresponding non infected control groups were included. Stools of infected mice were examined twice daily to determine; infection rate, prepatent period and intensity of infection. Mice were sacrificed according to the schedule and the whole intestine was isolated and processed for histopathological examination by H & E and modified Ziehl Nielsen stain, and histochemical examination for acid and alkaline phosphatase activity. The results revealed that the infection rate was 90% and prepatent period 3-5 days and the course of infection was 21 days. The maximum pathological changes were in the ileum. These changes were reversible.

Contraception and community in Egypt: a preliminary evaluation of the population/development mix

Egypt's Population and Development Program (PDP) is an effort to combine family planning and development approaches at the grass roots level. Introduced as a pilot project in the late 1970s, it is now active in nearly three quarters of Egypt's villages. A 1980 Contraceptive Prevalence Survey of over 5,000 rural women stratified 124 villages according to their exposure to the program (from zero to two or more years). Comparison of women living in villages of varying exposure revealed no differences in fertility; but modest differences in knowledge, attitudes, and contraceptive practice were apparent, especially in Upper Egypt. A multivariate analysis with socioeconomic and demographic controls did not weaken these relationships. Moreover, program effects were most marked among those most in need of services--noncontracepting fecund women who were illiterate.

Turbulence measurements with pulsed Doppler ultrasound employing a frequency tracking method

A phase lock loop method of tracking doppler ultrasound frequencies is applied to the measurement of turbulent velocities. A pulsed Doppler ultrasound system capable of detecting two velocity components was employed to resolve axial and radial velocity components at the centerline of turbulent pipe flows and distal to stenoses in pulsatile flow. Measurements with the ultrasound system are compared with laser Doppler and hot film anemometer data. The results demonstrate that the phase lock loop method of tracking accurately follows turbulent velocity fluctuations for turbulence intensities up to approx. 20%, after which signal dropout becomes a significant factor. An important application of the method is that of detecting flow disturbances created by mild to moderate degrees of stenosis in arterial disease.

The influence of wife's education on fertility in rural Egypt

Based on survey data from rural Egypt, the effects of the wife's education on fertility and family planning were investigated and shown to be very important. In accordance with the results of most other studies, there is an inverse relationship with the number of live births. The wife's education is also shown to influence attitudes towards family size, spacing, and knowledge and approval of contraceptives, all of which lead to a high proportion of contraceptive use and help to achieve the desired family size. There was also a clear inverse association between the wife's education and pregnancy loss and infant mortality; these latter two variables showed positive correlations with the number of live births.

(Summary in Arabic on p. 60)