Resistance patterns of bacterial pathogens causing lower respiratory tract infections: Aleppo-Syria

Globally, lower respiratory tract infections (LRTIs) are one of the lead causes of death. Bacterial and susceptibility profiles are not constant over time and geographically, and different patient factors can be correlated with those infections.

Objective

This study aimed to scan the bacterial spectrum causing LRTIs, their susceptibility profile and patient related risk factors.

Material and methods

Two hundred sixty-eight specimens from LRTIs suspected patients attending University Hospital were collected. Specimens included bronchial washings, transtracheal aspiration samples and sputum. After appropriate culture and identification tests, susceptibility test was done using minimum inhibitory concentration method. Data were collected from patients for further analysis.

Results

of total specimens, 150 showed positive culture results (Acinetobacter baumannii, Pseudomonas aeruginosa, Citrobacter koseri, Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus, Streptococcus pneumonia and Candida spp.). The antibiogram showed high resistance among all bacterial isolates against most antibiotics. Good susceptibility rates were shown to colistin in Gram-negative group and piperacillin\tazobactam in Gram-positive group. Trimethoprim\sulfamethoxazole showed good susceptibility results in both groups. Many factors showed correlation with LRTIs such as age (P=0.004), smoking (P=0.049), residency (P=0.043), hypertension (P=0.012), lung chronic disease (P=0.007) and cancer (P=0.048).

Conclusion

The leading cause of LRTIs in our study were A. baumannii and P. aeruginosa which both are very troublesome pathogens and multidrug resistant frequency was alarming. Random empirical antibiotic using can highly lead to increased resistance. Further care must be taken after patients with risk factors, and adjustments should be done to those modifiable factors.

Anxiety and depression among patient's companions during admission to the ICU in the Omicron wave of COVID-19: A cross-sectional study in Aleppo University Hospital

BACKGROUND

After the COVID-19 pandemic, anxiety and depression have reached high levels, especially after the last wave, Omicron. Healthcare workers in contact with COVID-19 patients or those who come in contact with them may exhibit high levels of anxiety and depression. Therefore, we aimed to assess anxiety and depression symptoms among ICU companions of COVID-19 patients.

METHODS

From 30 November 2021 to 1 March 2022, sixth-year medical students at Aleppo University Hospital conducted interviews with the companions of COVID-19 patients who they brought their patient to the ICU centre as part of a cross-sectional quantitative study using the PHQ-9 and GAD-7 tools to gauge their level of anxiety and depression among companions of COVID-19 patients. The data were analyzed using the SPSS program. In addition, logistic regression models were used to study possible factors of anxiety and depression symptoms during COVID-19.

RESULTS

The total number was 997 participants in contact with COVID-19 patients. The mean score of the depression assessment tool (PHQ-9) in our questionnaire was 9.5 with a range of 0 to 27. At the same time, the anxiety assessment tool (GAD-7) had a mean score of 9.1, ranging from 0 to 21. A binary logistic regression was used to predict the relationship between depression and anxiety and various factors. We found that the companions with medical specialties were substantially less likely to develop anxiety than other companions [AOR = 0.459; 95%CI (0.23-0.9)], in addition females were substantially higher likely to develop depression than males [AOR = 1.322; 95%CI (0.992-1.762)]. 45.4% of companions had moderate to severe anxiety, in additon 50.8% of companions had moderate to severe depression.

CONCLUSION

Our research reveals that moderate to severe anxiety and sadness are present in roughly half of the COVID19 patients' companions. Females, people with children, and hard workers were more inclined to feel anxious than others, and those who are not in the medical field were more likely to suffer from depression than others, thus it is critical to assist these groups during the present outbreaks (Omicron and Monkeybox).

Knowledge and attitudes about influenza and the common cold in Syria post COVID-19: A qualitative study

Background

The common cold and the influenza are common infections that are frequent in the community. In this study, we estimate the level of knowledge regarding those diseases among the Syrian population in the COVID era as it is important to have this knowledge for future health planning and policies.

Methods

A qualitative study was conducted from November to December in 2021. A structured self-administered questionnaire was distributed as Google Forms on social media platforms and hard copies of the questionnaire to patients, their companions, or workers in public hospitals. Chi-square test and Mann Whitney test were used to study the associations between categorical groups.

Results

This study included 13013 participants, 7856 (60.4%) were females, 78.4% were younger than 31 years old, only 3518 (27%) knew that the common cold and the influenza were caused by viruses, 6146 (47.2%) reported that runny nose was the most annoying symptom, 75.6% of the participants believed that antibiotics could kill viruses, and 7674 (58.9%) had fears from symptoms of common cold and influenza because of covid-19. Females were statistically significantly more knowledgeable and had more fears from the infection compared with males.

Conclusion

This study showed a low level of knowledge among the Syrian population. The view of influenza and common cold have changed after COVID as they are now taken more seriously. Many efforts should be made to spread awareness, effective management, and reducing antibiotic misinformation.

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The public in Syria mostly cannot distinguish between common cold and influenza.

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They still believe that antibiotics is the treatment of choice for them.

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COVID-19 has made people more aware and self-conscious of having flu-like symptoms as they can be from having COVID.

Peritoneal effusion as unusual complication post COVID 19 infection

Introduction

COVID 19 is a new virus appeared in the late of 2019, and spread widely through the world, causing respiratory symptoms and sometimes could cause digestive manifestations.

Case presentation

We reported a case of a 72 years old women presented with a complaint of dry cough, dyspnea and swollen abdomen, which she diagnosed with COVID19 and her medical history showed type 2 diabetes mellitus and acute kidney injury one month prior to her presentation. CT-abdomen showed Ascites and slightly hepatomegaly then we performed prednisolone antibiotics medication. After a week the Ascites decreased and her condition was good and stable.

Discussion

Few similar cases have been reported in the literature as case reports, but our article reports the first case report from Syria, which may increase the clinical awareness towards rare complications of COVID19 infection among Syrian clinical doctors, especially pulmonologists.

Conclusion

The peritoneal effusion consider as s rare digestive manifestation of COVID19 that Clinical doctors should take aware off.

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Digestive manifestations were reported in COVID19 patients such as nausea, vomiting, diarrhea, anorexia and liver injury.

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Peritoneal effusion is consider an extremely rare complication post COVID 19 infection, which there were few number of similar cases in the literature.

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Clinical doctors should investigate the existence of ascites when finding COVID19 patient with digestive symptoms.

Subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patient: The first case report in Syria

The complications of covid-19 may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Subcutaneous emphysema with as a complication of covid-19 has been documented in a few cases in the medical literature as case reports. A 36-year-old patient with covid-19 complained of symptoms of fever and dyspnea with no history of trauma or smoking. After computed tomography scan and x-ray, it was found that there was Subcutaneous emphysema and spontaneous pneumomediastinum. The medical treatment of corticosteroids and intravenous anticoagulant was immediately performed to improve the patient's condition significantly. The patient was discharged with nearly full recovery. We did the following-up for the patient and the results were good. The combination of these two complication is a reality for Covid-19 patients, so a quick and accurate diagnosis and continuous follow-up should be taken into account to avoid the danger to the patient's life as a result of the formed dyspnea.

A new species of Neoblattella Shelford (Blattellidae: Pseudophyllodromiinae) from Amazonas State, Brazil

Neoblattella mista sp. nov. is described and illustrated based on male genitalia and morphological characters of a single specimen collected in the town of Coari, State of Amazonas, Brazil. By studying the literature on the genus, we determined that N. mista sp. nov. differs from the other four known complexes in the morphology of its genital structures, including the supra-anal plate, subgenital plate, right and left phallomeres, median genital sclerite and tergal modification in the abdomen, and is placed in the new "mista complex".

A multinational study of treatment failures in asthma management

SETTING

Emergency rooms.

OBJECTIVE

To assess quality of care and its determinants for asthma patients before emergency room treatment.

DESIGN

Consecutive patients with acute severe asthma attending emergency rooms were questioned about the severity of their disease and treatment in the previous 4 weeks. Prescriptions of inhaled corticosteroids were recorded. Other outcomes included self-reported adherence to treatment and loss of work.

RESULTS

Thirteen centres in 11 countries recruited 1156 patients. Only 36% of patients with persistent asthma had been prescribed an adequate dose of inhaled corticosteroids. This percentage improved in those receiving regular care from the same doctor (OR 2.86, 95%CI 1.38-5.96), and was at least as good for the 10% of patients receiving 'private' health care (OR 3.08, 95%CI 1.69-5.62). Forty-four per cent of patients had health insurance covering some asthma medications. These patients were more likely to be receiving adequate inhaled corticosteroids (OR 1.74, 95%CI 1.17-2.58), and reported better adherence than those without insurance (OR 3.00, 95%CI 1.64-5.50). Of those on adequate inhaled corticosteroids, 18% had lost work in each of the 4 previous weeks compared with 59% among those more than one treatment step below the recommended dose.

CONCLUSIONS

Access to adequate treatment is critical for better management of asthma.

Colchicine for large pericardial effusion

On the basis of our reported experience with colchicine for recurrent pericarditis, we administered colchicine to two patients with large pericardial effusions complicating idiopathic pericarditis. The first was a 26-year-old male who showed clinical deterioration following emergency pericardiocentesis and aspirin (3 g/day) for 10 days; the second was a 2-year-old girl who was unsuccessfully treated with aspirin (100 mg/kg/day) for 2 weeks, followed by corticosteroids for 7 months. Administration of colchicine (1 mg/day) instead of aspirin in the first case, and with a rapid tapering-off of the corticosteroids in the second case, led to complete regression of the pericardial effusion on echocardiography within 1 week and 1 month, respectively. Colchicine was discontinued after 1 month in the first patient and was continued for 6 months in the child. Neither has had a recurrence at 24 and 6 months of follow-up, respectively. No side effects of colchicine were observed. We conclude that colchicine may be effective in the treatment of large pericardial effusion when therapy with nonsteroidal anti-inflammatory drugs and/or corticosteroids fails.

A family with a syndrome of ectopia lentis, spontaneous filtering blebs, and craniofacial dysmorphism

Six members of a family presented with a syndrome of mild facial dysmorphism, subluxation of the crystalline lenses, variable degrees of angle closure by iridocorneal adhesions, and patchy areas of iris atrophy. Three nonoperated eyes of two patients had spontaneous filtering blebs that presented as avascular cystic elevations of the superior conjunctiva. Systemic workup of all patients was negative for evidence of diseases known to be associated with dislocated lenses. The pedigree is most compatible with autosomal recessive inheritance with pseudodominance.