Atypical Complications during the Course of COVID-19: A Comprehensive Review.

COVID-19 is primarily a respiratory disease, but numerous studies have indicated the involvement of various organ systems during the course of illness. We conducted a comprehensive review of atypical complications of COVID-19 with their incidence range (IR) and their impact on hospitalization and mortality rates. We identified 97 studies, including 55 research articles and 42 case studies. We reviewed four major body organ systems for various types of atypical complications: (i) Gastro-intestinal (GI) and hepatobiliary system, e.g., bowel ischemia/infarction (IR: 1.49-83.87%), GI bleeding/hemorrhage (IR: 0.47-10.6%), hepatic ischemia (IR: 1.0-7.4%); (ii) Neurological system, e.g., acute ischemic stroke/cerebral venous sinus thrombosis/cerebral hemorrhage (IR: 0.5-90.9%), anosmia (IR: 4.9-79.6%), dysgeusia (IR: 2.8-83.38%), encephalopathy/encephalitis with or without fever and hypoxia (IR: 0.19-35.2%); (iii) Renal system, e.g., acute kidney injury (AKI)/acute renal failure (IR: 0.5-68.8%); (iv) Cardiovascular system, e.g., acute cardiac injury/non-coronary myocardial injury (IR: 7.2-55.56%), arrhythmia/ventricular tachycardia/ventricular fibrillation (IR: 5.9-16.7%), and coagulopathy/venous thromboembolism (IR: 19-34.4%). This review encourages and informs healthcare practitioners to keenly monitor COVID-19 survivors for these atypical complications in all major organ systems and not only treat the respiratory symptoms of patients. Post-COVID effects should be monitored, and follow-up of patients should be performed on a regular basis to check for long-term complications.

Phylogenetic diversity and mutational analysis of New Delhi Metallo-ß-lactamase (NDM) producing E. coli strains from pediatric patients in Pakistan.

The evolution of NDM genes (bla NDM) in E. coli is accounted for expansive multidrug resistance (MDR), causing severe infections and morbidities in the pediatric population. This study aimed to analyze the phylogeny and mutations in NDM variants of E. coli recovered from the pediatric population. Carbapenem-resistant clinical strains of E. coli were identified using microbiological phenotypic techniques. PCR technique used to amplify the bla NDM genes, identified on agarose gel, and analyzed by DNA sequencing. The amino acid substitutions were examined for mutations after aligning with wild types. Mutational and phylogenetic analysis was performed using Lasergene, NCBI blastn, Clustal Omega, and MEGA software, whereas PHYRE2 software was used for the protein structure predictions. PCR amplification of the bla NDM genes detected 113 clinical strains of E. coli with the contribution of bla NDM-1 (46%), bla NDM-4 (3.5%), and bla NDM-5 (50%) variants. DNA sequencing of bla NDM variants showed homology to the previously described bla NDM-1, bla NDM-4, and bla NDM-5 genes available at GenBank and NCBI database. In addition, the mutational analysis revealed in frame substitutions of Pro60Ala and Pro59Ala in bla NDM-4 and bla NDM-5, respectively. The bla NDM-1 was ortholog with related sequences of E. coli available at GenBank. The phylogenetic analysis indicated that the NDM gene variants resemble other microbes reported globally with some new mutational sites.

Antibiogram and recent incidence of multi-drug resistant carbapenemase producing Escherichia coli isolated from paediatric patients.

OBJECTIVE: To gauge the recent breadth of MDR E. coli along with antibiogram of carbapenemase producing (CP) E. coli among children from an institute which receives patients from all over Punjab. METHODS: The bacterial strains of E. coli isolated from various specimens of patients were collected from April 2017 to August 2018 and processed using standard biochemical tests and API 20E system (bioMerieux). Phenotypic screening for CP E. coli was done by the modified Hodge test, whereas antibiotic susceptibility testing was done with Kirby-Bauer disc diffusion technique. RESULTS: Total of 6,468 bacterial strains were isolated, out of which 1,552 (24%) were E. coli. Carbapenem resistance was observed in 245 (16%) strains, amongst which 113 (46%) were confirmed to be CP. E. coli isolated from males were higher as compared to females (p<0.05). Majority of the organisms were isolated from blood (37.2%) samples. The hospital discharged about 65% of patients, while 23% left against medical advice. Overall MDR amongst E. coli was 93.26%. Colistin sulphate (15.9%) and nitrofurantoin (16.8%) showed the most efficacy followed by amikacin (15%) and fosfomycin (10.6%). CONCLUSION: The isolation of high number of MDR E. coli amongst the paediatric patients is worrisome, which could serve as a potential source of horizontal genes transfer to other genera.

Antibacterial activity of penicillins alone and in combination with different agents against Staphylococcus aureus.

Difficulties in the treatment of the resistant strains of Staphylococcus aureus, which is a frequent cause of nosocomial infections in paediatric patients, has prompted this research to empower the usage of various combinations of penicillin. During the study period 17,452 clinical samples were processed for culture. The positive cultures yielded 564 strains of S. aureus. Out of these, 362 (64.2%) isolates were found to be methicillin sensitive S. aureus (MSSA) and 202 (35.8%) methicillin resistant S. aureus (MRSA). The frequency of S. aureus isolates from male patients (355; 63.1%) was found to be higher than female patients (209; 36.9%) and those from indoor wards (441; 78.2%) were more than the outdoor wards (123; 21.8%). Frequency distribution of S. aureus showed to be highest among blood 342 (60.6%) and cerebrospinal fluid 100 (17.8%) samples. The sensitivity pattern of MSSA with piperacillin-tazobactam was 344 (95.0%), ampicillin-sulbactam 340 (93.9%), co-amoxiclav 332 (91.8%) and ampicillin-oxacillin 257 (71.0%). MRSA susceptibility to piperacillin-tazobactam was 143 (71.0%), ampicillin-sulbactam 114 (56.6%), co-amoxiclav 61 (30.2%) and ampicillin-cloxacillin 18 (9%). The Cochran Mantel Haenszel test showed that the effectiveness for each penicillin was associated significantly (p<0.05) with both the MSSA and MRSA. The combinations of piperacillin-tazobactam, ampicillin-sulbactam, co-amoxiclav and ampicillin-cloxacillin exhibited higher efficacy than using them alone to combat Staphylococcal infections.