COVID-19 Vaccination Among the Arab Bedouin Population: Lessons Learned From a Minority Population.

Objectives: We investigated the causes of low COVID-19 vaccination rates among a minority population and highlighted interventions for increasing the vaccination rate. Methods: We reviewed the experience during the mass vaccination campaign period among the Arab Bedouin (AB) in Israel, attempting to determine important causes of low vaccination rates and gathered information from real-life experience and through direct contact with the population during the campaign. Results: Causes for low vaccination rates in the AB are related to the health system infrastructure, crisis management strategies, and population characteristics. Long-standing socioeconomic inequalities, limited resources, and language and culture barriers present special challenges to the task of COVID-19 vaccination campaigns. Key interventions for increasing vaccination rates among minority populations include raising awareness, improving vaccination access, and directly targeting risk-groups. To maximize the effectiveness of these interventions they should be culturally adapted and executed according to the needs of each individual target community. Conclusion: Culturally adapted awareness campaigns, interventions, and improved access to vaccines can be accomplished by cooperation between relevant governing and community bodies to increase COVID-19 vaccination rates among minorities.

Rapid phenotypic assay of antimycobacterial susceptibility pattern by direct mycobacteria growth indicator tube and phage amplified biological assay compared to BACTEC 460 TB.

The performance of antimycobacterial susceptibility testing for the first line drugs (isoniazid, streptomycine, rifampicin and ethambutol) with mycobacteria growth indicator tube (MGIT) and by bacteriophage amplified biological assay by FAST-plaque TB-MDR were compared to automated radiometric BACTEC 460 TB system. This study was carried on 84 sputum samples of positive Zhiel-Neelsen (ZN) smears. Sputum samples were subjected to culture and antimycobacterial susceptibility testing by BACTEC 460 TB. Samples were also tested by direct susceptibility tests for isoniazid (INH), ethambutol, rifampicin (RIF) and streptomycine by MGIT. Sensitive and resistant isolates for RIF were further studied by FAST-plaque TB-MDR for RIF resistance. The commonest resistance pattern by BACTEC 460 TB was for INH (32%) followed by RIF (24%) either alone or in combination with other drugs. Multiple drugs resistance was 20%. The agreement between BACTEC 460 TB and direct MGIT for resistant strains was 100% for INH and ethambutol, 91.7% for rifampicin, 80% for streptomycine and was 90% for MDR. FAST-plaque TB-MDR detected correctly all RIF resistant strains and 97.2% of the sensitive strains. For majority of strains direct susceptibility tests were available within 6.34-6.404 days (95% confidence interval) with direct mycobacteria growth tube, while results for FAST-plaque TB-MDR appear within 10.5-11.5 days from the time that the sputum was received in the laboratory (95% confidence interval). From this study, we could conclude that direct MGIT AST is the quickest method for screening antimycobacterial susceptibility pattern for the drugs commonly used (INH, RIF, etambutol, streptomycin) as results were available within 6.34-6.404 days. Also FAST-plaque TB-MDR method is accurate for detection of rifampicin resistance after primary culture which can be used as a surrogate marker for presence of MDR strains and the results were available within 10.5-11.5 days.

Nonalcoholic fatty liver disease in patients with acute ischemic stroke is associated with more severe stroke and worse outcome.

BACKGROUND: There is a paucity of data regarding the association between nonalcoholic fatty liver disease (NAFLD) and acute ischemic stroke. Stroke is largely preventable, so that knowledge of risk factors is essential to achieve reductions in the stroke rate and resulting disease burden. OBJECTIVE: The aim of the present study was to evaluate the prognostic value of NAFLD on stroke severity and outcome. METHODS: We prospectively studied 200 patients who were admitted with acute ischemic stroke between September 2013 and August 2015. Demographic and vascular risk factors were detailed for all subjects. The severity of stroke was assessed with National Institutes of Health Stroke Scale score at admission. NAFLD was defined as serum alanine aminotransferase and/or aspartate aminotransferase levels above the upper limit of normal in the absence of other causes of elevated aminotransferase levels. The outcome was assessed with the modified Rankin scale score at discharge. RESULTS: NAFLD was found in 42.5% of the study population. The prevalence of diabetes was significantly higher among patients with NAFLD than those without NAFLD (P = .001). Waist circumference was significantly higher among patients with NAFLD than those without NAFLD (P < .05). Patients with NAFLD had significantly higher glucose, Triglycerides, Low density lipoprotein, serum alanine aminotransferase and aspartate aminotransferase than those without NAFLD (P < .05 for each comparison). National Institutes of Health Stroke Scale score at admission and modified Rankin scale score at discharge were significantly higher in patients with NAFLD than those without NAFLD (P < .05 for each comparison). CONCLUSION: NAFLD was found in 42.5% of acute ischemic stroke patients. NAFLD might be associated with more severe stroke and worse outcome.

Accelerated neutrophil apoptosis in neutropenic patients with hepatosplenic schistosomiasis is induced by serum Fas ligand.

Neutropenia in patients with hepatosplenic (HS) schistosomiasis may stem from enhanced neutrophil apoptosis. However, the molecular mechanism of neutrophil apoptosis has not been clearly defined. Neutrophils harvested from neutropenic patients with HS schistosomiasis (n = 25), non-neutropenic patients with hepatointestinal (HI) schistosomiasis (n = 10), and age- and sex-matched healthy control subjects (n = 10) were examined for the degree of apoptosis after incubation with autologous sera. Neutrophil apoptosis was quantified by flow cytometry through determination of propidium iodide nuclear staining and confirmed by DNA gel electrophoresis at 0 time (fresh neutrophil), 4 and 24 h culture. Neutrophils from healthy subjects were also incubated with either 10% heterologous normal or neutropenic serum, with and without anti-Fas ligand antibody. Serum Fas ligand levels were assessed in sera of patient groups and healthy controls by ELISA. Compared with normal controls and HI, HS group demonstrated greater neutrophil apoptosis in the presence of autologous serum (P < 0.01, < 0.05, respectively). Furthermore, compared with normal neutrophils exposed to heterologous normal serum, those exposed to heterologous neutropenic serum exhibited higher apoptosis rates (P < 0.01). The apoptotic effect of neutropenic sera is attenuated by anti-Fas ligand. Fas expression was significantly higher in HS group as compared to both HI and normal healthy controls (P < 0.05). Serum Fas ligand levels were significantly higher among HS group as compared to both HI and control groups (P < 0.01 for both). Neutrophil apoptosis was not correlated to the size of spleen in HS group. In conclusion, the rate of neutrophil apoptosis is accelerated in neutropenic HS schistosomiasis. These findings suggest that enhanced neutrophil apoptosis demonstrated in HS patients is triggered by soluble Fas ligand, which is mostly derived from spleen.

Neuropsychiatric manifestations in a consecutive cohort of systemic lupus erythematosus; a single center study.

OBJECTIVES: To identify the prevalence and the possible risk factors of occurrence and severity of neuropsychiatric (NP) manifestations in systemic lupus erythematosus (SLE). PATIENTS AND METHODS: This is a cross-sectional study. The assessment of SLE patients is based on rheumatologic, neurologic and psychiatric evaluation, immunoserologic testing, and cerebral magnetic resonance imaging (MRI). Factors associated with NP manifestations were explored using regression models. RESULTS: Of 84 SLE patients included in this study, 36 (42.9%) had neuropsychiatric manifestations. Among these 36 patients, 34 (94.4%) were female and two (5.6%) were male. The most frequent manifestations were mood disorders, headache and anxiety disorder. Of 36 patients with NP-SLE; 16 patients have severe NP manifestations (≥ 3 NP manifestations). In univariate analysis, the risk factors that associated with severe NP manifestations included more organ damage, cutaneous vasculitis, nephritis flare, the presence of antiphospholipid antibodies, particularly lupus anticoagulant and anti-cardiolipin immunoglobulin G (IgG aCL), abnormal MRI of the brain and aggressive use of immunosuppressives. However, in multiple regression analysis, nephritis, cutaneous vasculitis, and IgG aCL were the only risk factors of severe NP manifestations. CONCLUSIONS: Due to the high prevalence of NP manifestations and its severity in SLE patients, systematic assessment to provide prompt diagnosis, early recognition of risk factors and appropriate intervention for NP lupus are essential.

Clinico-pathological study of atypical pathogens in community-acquired pneumonia: a prospective study.

BACKGROUND: Atypical respiratory pathogens such as Mycoplasma pneumoniae, Legionella species, and Chlamydia pneumoniae are isolated with increasing frequency from community-acquired pneumonia (CAP). This study highlights the importance of organisms responsible for CAP. METHODOLOGY: One hundred consecutive patients with clinically and radiographically diagnosed CAP were evaluated from October 2005 to October 2006. Sputum, bronchoalveolar lavage, and blood samples were collected for microbiological culture. Determination was performed for specific immunoglobulin M (IgM) for Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Coxiella burnettii, adenovirus, and influenza virus. RESULTS: The most common isolated bacteria was Streptococcus pneumoniae (22%) followed by Haemophilus influenzae (18%). Mycoplasma pneumoniae was isolated from 5% and Legionella pneumophila was isolated from 5% of patients. The most common positive serological reaction was for Chlamydia pneumoniae (30%) and Adenovirus (30%). In the study of accuracy of determination of specific IgM for Mycoplasma pneumoniae and Legionella pneumophila compared to culture, the sensitivity was 60% and 80% respectively, specificity was 93.7 %, and 98.9 % respectively, and accuracy was 92 % and 97 % respectively. CONCLUSION: This study highlights the prominence of mixed bacterial/viral infections in lower respiratory tract infection diagnosis. Our data showed that at least 30% of our patients had concurrent infections. This observation raises two important questions: 1) whether sequential or concurrent viral and bacterial infections have a synergistic impact on the evolution of disease in children; and 2) should diagnostic batteries for any patient with CAP include methods for detecting both the typical and atypical bacterial or viral pathogens.

Soluble VEGF/sFLt1 ratio is an independent predictor of AML patient out come.

Angiogenesis is the formation of new blood vessels and is controlled by a balance between positive and negative angiogenic regulatory factors. Soluble vascular endothelial growth factor receptors 1,2 (Flt-1, KDR) are the negative counterpoint to the vascular endothelial growth factor (VEGF) signaling pathway, which has been characterized as one of the most important endothelial regulator in human angiogenesis. In the present work, we tested the differential prognostic relevance of soluble vascular endothelial growth factor (VEGF), their receptors 1 (Flt-1), 2 (KDR), and the ratio between sVEGF/sFlt-1 in 43 patients with acute myeloid leukemia (AML). sVEGF and its soluble receptors were assessed using an ELISA. Soluble VEGF, sFLT-1 and sKDR concentration levels were significantly higher in AML patients at diagnosis when compared to the levels in normal controls. sVEGF, sFlt1 and the sVEGF/sFlt1 ratio were significantly higher in non responders when compared to responders (P < 0.001 for all). However, there was no significant difference regarding sKDR levels (P > 0.05). sVEGF, the sVEGF/sFlt1 ratio but not sFlt1 and sKDR levels were significantly elevated in those who did not survive, when compared to survivors. sVEGF, sFlt1 levels were significantly correlated to WBC counts (R = 0.93, P = 0.000, R = 0.56, P = 0.000, respectively); bone marrow blast cell counts (R = 0.92, P = 0.000; R = 56, P = 0.000, respectively); peripheral blood blast cell counts (R = 0.91, P = 0.000; R = 0.52, P = 0.000, respectively); sKDR was only correlated to peripheral blood blast cell counts(R=0.37,P=0.014). Cox regression analysis results with sVEGF, sFlt1, sKDR, sVEGF/sFlt1 ratio suggest that the most important predictor for AML outcome is the sVEGF/sFlt1 ratio. In conclusion, sVEGF/sVEGF ratio is independent predictor of AML patient out come, and its significance should be assessed when considering antiangiogenic therapy.