Case report: disease mechanisms and medical management of calcium nephrolithiasis in rheumatologic diseases.

BACKGROUND: Nephrolithiasis as a feature of rheumatologic diseases is under recognized. Understanding presenting features, diagnostic testing is crucial to proper management. CASE PRESENTATION: A 32 year old woman with a history of recurrent complicated nephrolithiasis presented to a rheumatologist for a several month history of fatigue, dry eyes, dry mouth, arthralgias. She had a positive double-stranded DNA, positive SSA and SSB antibodies. She was diagnosed with Systemic Lupus erythematosus (SLE) and Sjogren's syndrome and was started on mycophenalate mofetil. Of relevance was a visit to her local emergency room 4 years earlier with profound weakness with unexplained marked hypokalemia and a non-anion gap metabolic acidosis. Approximately one year after that episode she developed flank pain and nephrocalcinosis. She had multiple issues over the ensuing years with stones and infections on both sides. Interventions included extracorporeal shockwave lithotripsy as well as open lithotomy and eventual auto-transplantation of left kidney for recurrent ureteric stenosis. 24 h stone profile revealed marked hypocitraturia, normal urine calcium, normal urine oxalate and uric acid. She was treated with potassium citrate. Mycophenolate was eventually stopped due to recurrent urinary tract infections and she was started on Belimumab. Because of recurrent SLE flares, treatment was changed to Rituximab (every 6 months) with clinical and serologic improvement. Her kidney stone frequency gradually improved and no further interventions needed although she continued to require citrate repletion for hypocitraturia. CONCLUSIONS: Nephrolithiasis can be a prominent and even presenting feature in Sjogrens syndrome as well as other rheumatologic diseases. Prompt recognition and understanding disease mechanisms is important for best therapeutic interventions for kidney stone prevention as well as treatment of underlying bone mineral disease.

Comparison of comparable scald and contact burns in a porcine model: A preliminary report.

Whether the depth and healing of scalds and contact burns are similar is controversial. Due to water's greater heat capacity, we hypothesized that when exposed to similar temperatures and durations of exposure, burns caused by hot water would be deeper than those caused by contact with hot metal. Forty standardized burns were created in two anesthetized female domestic pigs using a brass bar or circulating heated water. In one pig, the temperature was kept constant (95°C) while the duration of exposure varied (5, 10, 15 seconds) In the second pig, the exposure time was kept constant (10 seconds) while the temperature of exposure varied (70°C, 80°C, 98°C). Periodic punch biopsies were taken to determine burn depth immediately after injury, percentage burns reepithelialized within 21 days, and depth of scar at 28 days. The analysis was performed using analysis of variance. When the temperature was held constant, duration of exposure (5, 10, and 15 seconds) was associated with scar depth (2.1 vs 3.8 vs 5.0 mm, respectively, P = 0.001) but not with burn depth (2.0 vs 2.2 vs 2.3 mm, respectively, P = 0.10). When exposure duration was held constant, temperature (70°C, 80°C, 98°C) was associated with scar depth (0.6 vs 1.7 vs 3.6, P < 0.001) but not with burn depth (1.2 vs 1.5 vs 1.7 mm, respectively, P = 0.21). Burn depths were greater for scald than contact burns although not significantly greater. After controlling for temperature, the difference in scar depth between scalds and contact burns was statistically significant (marginal means 3.0 for contact burns, 4.3 for scalds, P = 0.008). We conclude that burns created in swine with circulating hot water result in deeper scars than those created by contact with a brass bar when controlling for temperature and duration of exposure.

Analgesia to acidosis: metabolic acidosis due to chronic acetaminophen (paracetamol) use.

This case describes a rare occurrence of high anion gap metabolic acidosis due to chronic acetaminophen (paracetamol) usage, which can be confirmed by measuring 5-oxoproline (pyroglutamate), an organic acid metabolite. As acetaminophen is an extremely common drug prescribed in both inpatient and outpatient settings, a high degree of clinical suspicion is required to isolate it as the aetiology for metabolic acidosis. Management includes discontinuation of acetaminophen use and at times the supplementation of oral bicarbonate. Metabolic acidosis due to a high anion gap is commonly described by the mnemonic 'MUDPILES' in daily practice. A newer mnemonic, 'GOLD MARK' is proposed to be a more inclusive tool to assist in determining the cause of high anion gap metabolic acidosis, especially with such cases being reported.

The Effects of Endosomal Toll-like Receptor Inhibitors in an EBV DNA-Exacerbated Inflammatory Bowel Disease Mouse Model.

Epstein-Barr virus (EBV), a Herpesviridae family member, is associated with an increased risk of autoimmune disease development in the host. We previously demonstrated that EBV DNA elevates levels of the pro-inflammatory cytokine IL-17A and that inhibiting Toll-like receptor (TLR) 3, 7, or 9 reduces its levels. Moreover, this DNA exacerbated colitis in a mouse model of inflammatory bowel disease (IBD). In the study at hand, we examined whether inhibition of TLR3, 7, or 9 alleviates this exacerbation. Mice were fed 1.5% dextran sulfate sodium (DSS) water and administered EBV DNA. Then, they were treated with a TLR3, 7, or 9 inhibitor or left untreated. We also assessed the additive impact of combined inhibition of all three receptors. Mice that received DSS, EBV DNA, and each inhibitor alone, or a combination of inhibitors, showed significant improvement. They also had a decrease in the numbers of the pathogenic colonic IL-17A+IFN-γ+ foci. Inhibition of all three endosomal TLR receptors offered no additive benefit over administering a single inhibitor. Therefore, inhibition of endosomal TLRs reduces EBV DNA exacerbation of mouse colitis, offering a potential approach for managing IBD patients infected with EBV.

Displacement ventilation to avoid COVID-19 transmission through offices.

Respiratory infections such as COVID-19 can be spread by respiratory droplets with a diameter larger than 5-10 µ m or by droplet nuclei with a diameter smaller than 5 µ m . Besides wearing masks, fresh air should be supplied frequently in closed rooms to avoid infections. Constructing and operating new isolation rooms require time, money, and maintenance cost, which are scarce in the current pandemic and in many communities. Displacement ventilation may be a feasible and secure option in temporary hospitals and other buildings to control the disease. This paper investigates using CFD simulations how displacement ventilation systems can deliver high air quality, and thermal comfort and minimize the risk of COVID-19 infection in enclosed spaces.

Treatment and practical considerations of diabetic kidney disease.

Diabetic kidney disease (DKD) is a complication of diabetes that can lead to kidney failure. Over the years, several drugs have been developed to combat this disease. In the early 90s, angiotensin blockade (ACEi and ARBs) was introduced, which revolutionized the treatment of DKD. In recent years, newer drugs such as sodium-glucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, endothelin antagonists, and mineralocorticoid receptor antagonists (MRA) have shown great promise in reducing albuminuria and protecting the kidneys. These drugs are being used in combination with lifestyle modifications, patient education, and risk factor modification to effectively manage DKD. In this review, we will explore the latest pharmacological options, their efficacy, and their potential to revolutionize the management of this debilitating disease.

Triage of in vivo burn injuries and prediction of wound healing outcome using neural networks and modeling of the terahertz permittivity based on the double Debye dielectric parameters.

The initial assessment of the depth of a burn injury during triage forms the basis for determination of the course of the clinical treatment plan. However, severe skin burns are highly dynamic and hard to predict. This results in a low accuracy rate of about 60 - 75% in the diagnosis of partial-thickness burns in the acute post-burn period. Terahertz time-domain spectroscopy (THz-TDS) has demonstrated a significant potential for non-invasive and timely estimation of the burn severity. Here, we describe a methodology for the measurement and numerical modeling of the dielectric permittivity of the in vivo porcine skin burns. We use the double Debye dielectric relaxation theory to model the permittivity of the burned tissue. We further investigate the origins of dielectric contrast between the burns of various severity, as determined histologically based on the percentage of the burned dermis, using the empirical Debye parameters. We demonstrate that the five parameters of the double Debye model can form an artificial neural network classification algorithm capable of automatic diagnosis of the severity of the burn injuries, and predicting its ultimate wound healing outcome by forecasting its re-epithelialization status in 28 days. Our results demonstrate that the Debye dielectric parameters provide a physics-based approach for the extraction of the biomedical diagnostic markers from the broadband THz pulses. This method can significantly boost dimensionality reduction of THz training data in artificial intelligence models and streamline machine learning algorithms.

Nephrotic syndrome presented as a portal vein thrombosis: a case report.

Nephrotic syndrome (NS) is a clinical disorder characterized by significant proteinuria, hypoalbuminemia, hyperlipidemia, edema, and other complications. Urinary loss of clotting inhibitors, zymogens, and plasminogen; increased hepatic synthesis of fibrinogen and lipoproteins, and hemoconcentration due to fluid loss are some of the factors which predispose NS patients to hypercoagulable states like portal vein thrombosis. Case presentation: In the presenting case report, we described a 21-year-old woman with no history of NS and a hypercoagulable state who presented to our emergency department with severe generalized abdominal pain and lower limb edema. She was subsequently diagnosed with NS complicated with portal vein thrombosis and was admitted to our internal medicine unit. After 2 weeks of treatment, the patient was discharged in good health. Conclusion: Additional evaluation for newly onset NS with venous thrombosis should be needed in the presence of severe abdominal pain and lower limb edema even in a patient without a previous history of NS.

A case of varicella zoster infection in kidney transplant recipient using immunosuppressant.

Kidney transplant recipients must take lifelong immunosuppression to prevent acute or chronic allograft injury. However, they are also at risk for opportunistic infections due to compromised immune cell functionality. Disseminated HZ in kidney transplant recipients can result in a very high overall mortality rate of up to 30%. Here we described a 23-year-old male patient who presented to the emergency room with a complaint of high-grade fever, chills, and non-dermatomal lesion of varicella zoster skin infection that affected the face and trunk. After investigation the patient was diagnosed with chickenpox clinically and was managed with complete recovery and early hospital discharge.

Nonautoimmune overt hypothyroidism in the early stages of nephrotic syndrome: a case report from Somalia.

Nephrotic syndrome (NS) was first characterized in 1827 as the occurrence of proteinuria greater than or equal to 3.5 g/24 h, hypoalbuminemia (albumin≤3.0 g/dl), peripheral edema, hyperlipidemia, lipiduria caused by increased permeability of the renal glomerulus. Persistent proteinuria will eventually lead to hypothyroidism. Case presentation: In the presenting case, we reported a 26-year-old male patient with no known history of chronic disease who presented to the emergency department with a complaint of 1-week generalized edema, nausea, fatigue, and generalized ache in the extremities. He was diagnosed with NS complicated by hypothyroidism and was hospitalized for 3 weeks. After 3 weeks of treatment and close monitoring, the patient's clinical condition and laboratory investigations were improved, and was discharged in good health. Conclusion: Hypothyroidism in the early stages of NS is a rare entity which may be encountered and physicians should be aware that hypothyroidism can be seen at any stage of NS.

Acute cerebral ischemic stroke as a presentation of polycythemia vera: a case report and a review of literature.

Polycythemia vera (PV) is a disease of stem cells characterized by pan hyperplastic, malignant, and neoplastic bone marrow conditions. It is characterized by an increased absolute red blood cell count due to uncontrolled red blood cell synthesis, as well as excessive white blood cell and platelet production. Although the relationship between PV and stroke, especially ischemic stroke, is widely known around the world, no previous cases have been reported from Somalia. Case presentation: In the presenting study, we report a 60-year-old male patient who presented with a right-side weakness for 3 days. After laboratory and brain imaging, he was diagnosed with an acute cerebral infarct affecting the left basal ganglion secondary to PV. Conclusions: PV as the cause of ischemic stroke is a rare condition but can be encountered in clinical practice, and clinicians should be familiar with this combination.

Major cardiovascular events and associated factors among routine hemodialysis patients with end-stage renal disease at tertiary care hospital in Somalia.

Introduction: Cardiovascular complications are the most significant cause of death in patients undergoing routine hemodialysi (HD) with end-stage renal disease (ESRD). The main objective of this study is to determine the significant cardiac events and risk factors in patients undergoing routine hemodialysis in Somalia. Methods: We carried out a cross-sectional retrospective study in a single dialysis center in Somalia. Two hundred out of 224 were included. All of them had ESRD and were on hemodialysis during the study period between May and October 2021. The records of all patients were reviewed, and the following parameters were analyzed socio-demographic factors, risk factors for cardiovascular disease, and the presence of cardiovascular diseases. Results: The mean age was 54 ± 17.5 years (range 18-88 years), and 106 (53%) patients were males. The prevalence of a cardiovascular disease among hemodialysis patients was 29.5%. Moreover, the distribution of cardiovascular diseases was different; heart failure was the most common, about 27.1%, followed by coronary artery disease (17%), pericarditis and pericardial-effusion (13.6%), dysrhythmia (10.2%), cerebrovascular-accident (8.5%), and peripheral vascular disease (3.4%). About 176 (88%) participants had at least one modifiable cardiovascular risk factor. The most common modifiable cardiovascular risk factor was hypertension (n = 45, 25.1%), followed by anemia (n = 28, 15.6%) and diabetes (n = 26, 14.5%). Younger (18-30) participants were six times less likely to have cardiovascular events among hemodialysis than older age 0.4 (0.11-1.12). Conclusion: Low prevalence rate of cardiovascular complications was confirmed in ESRD patients receiving hemodialysis in the main HD center in Somalia. Diabetes, anemia, and hypertension were the highest significant risk factors for CVD in HD patients with ESRD in Somalia.

Hypokalemic periodic paralysis as the first sign of thyrotoxicosis- a rare case report from Somalia.

BACKGROUND: Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare complication of hyperthyroidism characterized by thyrotoxicosis, hypokalemia, and paralysis. It is the most common form of acquired periodic paralysis. THPP is precipitated by strenuous exercise, a high carbohydrate diet, stress, infection, alcohol, albuterol, and corticosteroid therapy. It is most common in Asian men with hyperthyroidism and exceptionally rare in black people. CASE PRESENTATION: A 29-year-old man was admitted to the emergency department in Somalia with a sudden onset of paralysis after a high carbohydrate meal. Laboratory investigations showed low serum potassium 1.8 mEq/l (3.5-4.5), and biochemical thyrotoxicosis with TSH 0.006 miu/l (0.35-5.1), total T3 3.2 ng/ml (0.9-2.8) and total T4 13.5 ng/ml (0.6-1.2). He was successfully treated with potassium chloride infusion and an antithyroid drug, methimazole. CONCLUSION: To prevent life-threatening cardiac and respiratory complications, it is critical to consider and diagnose THPP early, even in populations where the condition is rare.

Prevalence and Determinants of Hypothyroidism in Patients on Routine Hemodialysis in Somalia: A Cross-Sectional Study.

Introduction: In recent decades, the relationship between thyroid and kidney disease has drawn considerable attention. We aim to assess the prevalence and the determinants of hypothyroidism in hemodialysis patients in Somalia. Materials and Methods: This is a cross-sectional study which was conducted in the hemodialysis unit of Mogadishu Somalia Turkish Training and Research Hospital, between June 1 and July, 31 2022. A total of 301 patients who are routinely going to hemodialysis were included in the study. Demographic data including age, gender, and data regarding hemodialysis were extracted from hospital information system (HIS). All participants had their thyroid function test measured before hemodialysis sessions. Results: A total of 301 patients were examined. Their ages ranged from 40 to 66 years, with the median age being 54 (IQR= 40-66). Males were 167 (55.5%) compared to females 134 (44.5%). Hypertension was the most common comorbidity among the patients with 137 (45.5%). Diabetic kidney disease was the most common cause of renal failure in 138 patients (45.84%) followed by hypertensive kidney disease 100 (33.22%). The prevalence rate of hypothyroidism in hemodialysis patients in our study was 28%. In hypothyroidism patients 57.8% had subclinical hypothyroidism and 42.2% had overt hypothyroidism. 70.8% of our patients were in euthyroid status. Subclinical hypothyroidism was commonly seen in patients with diabetes, hypertension, and heart disease. We found that increasing age, decreased albumin level were related to higher risk of subclinical hypothyroidism. We also found that increasing creatinine levels were associated with lower risk of overt hypothyroidism. Conclusion: The prevalence rate of hypothyroidism in hemodialysis patients was 28%, with 57.8% showing subclinical hypothyroidism and 42.2% overt hypothyroidism. Increased age and low albumin level was associated with the prevalence of subclinical hypothyroidism in hemodialysis patients. Also low creatinine level was observed in overt hypothyroidism patients.

Epidemiology of End-Stage Renal Disease in Mogadishu, Somalia: First Report at a Tertiary Care Hospital.

Background: End-stage renal disease (ESRD) in Somalia remains unexamined due to a lack of a national registry system, and the impact of the disease in the country is not estimated yet. The present study is the first report that aims to evaluate the epidemiological characteristics, causes, and dialysis-related factors associated with readmissions in ESRD patients who were going to routine hemodialysis. Patients and methods: This cross-sectional observational study enrolled 208 patients with ESRD. Also, this study investigated patients readmitted to the hospital (n=135) after they enrolled in hemodialysis. The sociodemographic characteristics, risk factors, and comorbidities associated with these patients were reviewed. Admission site, length of hospital stay, outcome, and dialysis-related factors associated with readmissions in the first six months after being on a regular hemodialysis program were also assessed. Results: The mean age of the patients was 52.7±15.0 years, 43.3% were >60 years, and 61.5% were male. The most common cause was diabetes at 39.4%, followed by hypertension (35.6%) and 12.5% for postrenal obstruction. The prevalence of 6-month hospital readmissions was 65%. The most common dialysis-related factor associated with readmissions was uremic complications due to missed hemodialysis sessions (40%), vascular access/catheter infection (20%), and anemia (17.8%) (95% CI: 0.825-5.357, OR: 3.017, p<0.04). Female cases were more vulnerable to vascular catheter site infection, anemia, and hyponatremia (p<0.001). 27.5% of the patients were admitted to the intensive care unit (ICU), and the most common reason for ICU admissions was pulmonary edema (53.8%), sepsis (42.8%), and uremia due to hemodialysis skip (26.4%) (95% CI: 1.507-13.632, OR: 2.08, p=0.01). The mortality rate was 5.2%. Conclusion: The prevalence of unplanned hospital readmissions within six months was very high, and a missed hemodialysis session was identified as the leading cause. Inadequate knowledge, wrong social beliefs about the concept of dialysis and a lack of a health insurance system that covers the higher costs of each dialysis session are believed to be the causes of missed dialysis occasions.

Deep neural network classification of in vivo burn injuries with different etiologies using terahertz time-domain spectral imaging.

Thermal injuries can occur due to direct exposure to hot objects or liquids, flames, electricity, solar energy and several other sources. If the resulting injury is a deep partial thickness burn, the accuracy of a physician's clinical assessment is as low as 50-76% in determining the healing outcome. In this study, we show that the Terahertz Portable Handheld Spectral Reflection (THz-PHASR) Scanner combined with a deep neural network classification algorithm can accurately differentiate between partial-, deep partial-, and full-thickness burns 1-hour post injury, regardless of the etiology, scanner geometry, or THz spectroscopy sampling method (ROC-AUC = 91%, 88%, and 86%, respectively). The neural network diagnostic method simplifies the classification process by directly using the pre-processed THz spectra and removing the need for any hyperspectral feature extraction. Our results show that deep learning methods based on THz time-domain spectroscopy (THz-TDS) measurements can be used to guide clinical treatment plans based on objective and accurate classification of burn injuries.

Supervised machine learning for automatic classification of in vivo scald and contact burn injuries using the terahertz Portable Handheld Spectral Reflection (PHASR) Scanner.

We present an automatic classification strategy for early and accurate assessment of burn injuries using terahertz (THz) time-domain spectroscopic imaging. Burn injuries of different severity grades, representing superficial partial-thickness (SPT), deep partial-thickness (DPT), and full-thickness (FT) wounds, were created by a standardized porcine scald model. THz spectroscopic imaging was performed using our new fiber-coupled Portable HAndheld Spectral Reflection Scanner, incorporating a telecentric beam steering configuration and an f-[Formula: see text] scanning lens. ASynchronous Optical Sampling in a dual-fiber-laser THz spectrometer with 100 MHz repetition rate enabled high-speed spectroscopic measurements. Given twenty-four different samples composed of ten scald and ten contact burns and four healthy samples, supervised machine learning algorithms using THz-TDS spectra achieved areas under the receiver operating characteristic curves of 0.88, 0.93, and 0.93 when differentiating between SPT, DPT, and FT burns, respectively, as determined by independent histological assessments. These results show the potential utility of our new broadband THz PHASR Scanner for early and accurate triage of burn injuries.

Accurate and early prediction of the wound healing outcome of burn injuries using the wavelet Shannon entropy of terahertz time-domain waveforms.

Significance: Severe burn injuries cause significant hypermetabolic alterations that are highly dynamic, hard to predict, and require acute and critical care. The clinical assessments of the severity of burn injuries are highly subjective and have consistently been reported to be inaccurate. Therefore, the utilization of other imaging modalities is crucial to reaching an objective and accurate burn assessment modality. Aim: We describe a non-invasive technique using terahertz time-domain spectroscopy (THz-TDS) and the wavelet packet Shannon entropy to automatically estimate the burn depth and predict the wound healing outcome of thermal burn injuries. Approach: We created 40 burn injuries of different severity grades in two porcine models using scald and contact methods of infliction. We used our THz portable handheld spectral reflection (PHASR) scanner to obtain the in vivo THz-TDS images. We used the energy to Shannon entropy ratio of the wavelet packet coefficients of the THz-TDS waveforms on day 0 to create supervised support vector machine (SVM) classification models. Histological assessments of the burn biopsies serve as the ground truth. Results: We achieved an accuracy rate of 94.7% in predicting the wound healing outcome, as determined by histological measurement of the re-epithelialization rate on day 28 post-burn induction, using the THz-TDS measurements obtained on day 0. Furthermore, we report the accuracy rates of 89%, 87.1%, and 87.6% in automatic diagnosis of the superficial partial-thickness, deep partial-thickness, and full-thickness burns, respectively, using a multiclass SVM model. Conclusions: The THz PHASR scanner promises a robust, high-speed, and accurate diagnostic modality to improve the clinical triage of burns and their management.

In Vivo Assessment and Monitoring of Burn Wounds Using a Handheld Terahertz Hyperspectral Scanner.

The accuracy of clinical assessment techniques in diagnosing partial-thickness burn injuries has remained as low as 50-76%. Depending on the burn depth and environmental factors in the wound, such as reactive oxygen species, inflammation, and autophagy, partial-thickness burns can heal spontaneously or require surgical intervention. Herein, it is demonstrated that terahertz time-domain spectral imaging (THz-TDSI) is a promising tool for in vivo quantitative assessment and monitoring of partial-thickness burn injuries in large animals. We used a novel handheld THz-TDSI scanner to characterize burn injuries in a porcine scald model with histopathological controls. Statistical analysis (n= 40) indicates that the THz-TDSI modality can accurately differentiate between partial-thickness and full-thickness burn injuries (1-way ANOVA, p< 0.05). THz-TDSI has the potential to improve burn care outcomes by helping surgeons in making objective decisions for early excision of the wound.

Epidemiology of Multidrug Resistant Non-Fermentative Gram Negative Bacilli in Patients with Hospital Acquired Pneumonia: An Alarming Report from Somalia.

Introduction: There is a lack of data concerning hospital-acquired pneumonia (HAP) due to multidrug resistant non-fermentative gram-negative bacilli (MDR-NFGNB) in Somalia, and this study will aim to analyze the epidemiology of MDR-NFGNB among HAP patients in tertiary care hospital in Somalia. Materials and Methods: This is a retrospective study which evaluated the presence of MDR-NFGNB among 2003 HAP patients between June 2017 and May 2022 in a tertiary care hospital in Somalia. NFGNB were cultured on blood agar and eosin methylene blue agar and were then used BBL crystal system and oxidase biochemical assays for identification. Antimicrobial sensitivity and resistance were assessed using Mueller-Hinton agar. Results: A total of 160 confirmed cases of HAP due to NFGNB were examined. Among these, 114 (71%) were males compared to females (n = 46, 29%). The mean age was 49.49 ± 21.48. The overall prevalence rate of NFGNB among patients with HAP was 8%. It was more common in older patients and in patients with co-morbidities. Acinetobacter baumannii was the most common NFGNB with n = 93 (58%), followed by Pseudomonas aeruginosa (n = 55, 34%), and Stenotrophomonas maltophilia (n = 12, 8%). Regarding the antimicrobial sensitivity rate, Acinetobacter baumannii showed an overall resistance level of 82%, Stenotrophomonas maltophilia (81%), and Pseudomonas aeruginosa (62%). The rate of CR-NFGNB in our study was 79.4%. We found that 68.1% of NFGNB was multidrug resistant (MDR) pathogens. MDR patterns were more common in Acinetobacter baumannii infections (84%). MDR pathogens were strongly associated with ICU admissions (95% CI, 0.202-0.800, OR, 0.402, p value <0.009). Finally, the mortality rate of HAP caused by NFGNB in our study was 42.5%. Conclusion: The prevalence of NFGNB in HAP patients was 8%. These infections were more prevalent among men and the elderly. Acinetobacter baumannii and Stenotrophomonas maltophilia exhibited the highest antibiotic resistance rate. The MDR level of these pathogens was 68.1%.