Validation of a Manual Negative Pressure Wound Therapy Device (PragmaVAC) for Acute and Chronic Wounds: A Prospective, Randomized, Controlled Trial.

BACKGROUND: Negative pressure wound therapy (NPWT) is an alternative to the standard gauze dressings for wound treatment. Due to limited health resources, poor electrical supply, and high costs, NPWT in resource-constrained settings is inaccessible. In conflict-affected settings, civilian injuries typically involve traumatic wounds or chronic wound infections that affect the extremities. METHODS: PragmaVAC® is a manually operated NPWT device designed to increase accessibility to NPWT without the need of electrical power. We aimed to determine the clinical efficacy of PragmaVAC through a controlled, non-blinded open-label clinical trial in a resource-constrained locality. The endpoint was formation of granulation tissue sufficient for wound closure. RESULTS: Fifty-nine patients qualified for analysis (19 Gauze; 40 PragmaVAC). The mean age of participants was 49.25 years, 55.9% were male, and 42.4% were diabetic. Forty three wounds (72.9%) were acute, 44 wounds (74.6%) were clean-contaminated, and 34 wounds (57.6%) were localized to the lower limb. The average duration of treatment was 15.3 days in PragmaVAC vs 36.5 days in control, p = 0.013. Similarly, PragmaVAC required fewer number of dressing changes 2.7 vs 23.2 times, p < 0.0001, at a lower frequency of dressings 0.22/day vs 0.73/day, in the control group, p < 0.0001. CONCLUSIONS: PragmaVAC is associated with accelerated healing and less frequent requirement of dressing changes. The introduction of a manually operated, low-cost device in resource-constrained settings presents an opportunity to improve wound care outcomes, decrease interventions, and optimize usage of material and human resources.

SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict.

INTRODUCTION: Ten years of conflict has displaced more than half of Northwest Syria's (NWS) population and decimated the health system, water and sanitation, and public health infrastructure vital for infectious disease control. The first NWS COVID-19 case was declared on July 9, 2020, but impact estimations in this region are minimal. With the rollout of vaccination and emergence of the B.1.617.2 (Delta) variant, we aimed to estimate the COVID-19 trajectory in NWS and the potential effects of vaccine coverage and hospital occupancy. METHODS: We conducted a mixed-method study, primarily including modeling projections of COVID-19 transmission scenarios with vaccination strategies using an age-structured, compartmental susceptible-exposed-infectious-recovered (SEIR) model, supported by data from 20 semi-structured interviews with frontline health workers to help contextualize interpretation of modeling results. RESULTS: Modeling suggested that existing low stringency non-pharmaceutical interventions (NPIs) minimally affected COVID-19 transmission. Maintaining existing NPIs after the Delta variant introduction is predicted to result in a second COVID-19 wave, overwhelming hospital capacity and resulting in a fourfold increased death toll. Simulations with up to 60% vaccination coverage by June 2022 predict that a second wave is not preventable with current NPIs. However, 60% vaccination coverage by June 2022 combined with 50% coverage of mask-wearing and handwashing should reduce the number of hospital beds and ventilators needed below current capacity levels. In the worst-case scenario of a more transmissible and lethal variant emerging by January 2022, the third wave is predicted. CONCLUSION: Total COVID-19 attributable deaths are expected to remain relatively low owing largely to a young population. Given the negative socioeconomic consequences of restrictive NPIs, such as border or school closures for an already deeply challenged population and their relative ineffectiveness in this context, policymakers and international partners should instead focus on increasing COVID-19 vaccination coverage as rapidly as possible and encouraging mask-wearing.

Neurotrauma in the Syrian War: analysis of 41,143 cases from July 2013-July 2015.

INTRODUCTION: Despite nearly a decade of conflict, little is known about trauma and injuries resulting from the Syrian war. METHODS: Secondary analysis was conducted of an administrative dataset of patient presentations to a network of 95 war-affected hospitals in Syria from July 2013-July 2015. Logistic regression was performed to identify factors associated with mortality of neurotrauma patients. RESULTS: Of 193,618 overall trauma presentations, 41,143 were for neurotrauma (37,410 head trauma, 1407 spinal trauma, and 3133 peripheral nervous system). There were 31,359 males (76.2%) and 9784 females (23.8%). Males aged 19-30 years (10,113; 24.6%) were the largest single demographic group. Presumed non-combatants including females, elders, and children under 13 years (16,214; 39.4%) were the largest group of patients overall. There were 16,881 (41.0%) presentations with blunt injuries (blunt/crush injuries) and 21,307 (51.8%) patients with penetrating injuries (shrapnel, cut, gunshot). A total of 36,589 patients (89.6%) were treated and discharged from the hospital, 2100 (5.1%) were transferred to another facility, 2050 patients (5.0%) died in-hospital, 26 remained in the hospital (0.1%), and 108 (0.3%) had unknown disposition. The median length of hospital stay was 1 day. There were 4034 (9.7%) neurosurgical procedures documented. Patients with combined neurotrauma and general trauma suffered 30 times higher mortality than neurotrauma alone (aOR: 30.4; 95% CI: 20.8-44.2, p < 0.0001). CONCLUSION: The Syrian War resulted in large volumes of neurotrauma patients. Presumed non-combatants comprised 39.4% of patients who survived to treatment at a facility. Further study is needed on long-term needs of neurotrauma victims of the Syrian war.

CLINICAL AND LABORATORY JUSTIFICATION FOR USE OF POLYVALENT BACTERIOPHAGE IN TECHNIQUE OF DELAYED PRESCRIBING OF ANTIBIOTICS IN PATIENTS WITH ARS.

OBJECTIVE: The aim: Of research was to evaluate the effectiveness of bacteriophage in patients with acute rhinosinusitis in respect of technique of delayed prescribing of antibiotics. PATIENTS AND METHODS: Materials and methods: There were examined 155 patients who were given irrigation therapy with isotonic solution of sea water 4 times a day and mometasone furoate of 100 mg twice a day for 10 days. The patients of intervention group (n - 80) were additionally prescribed the polyvalent bacteriophage endonasally, in drops of 2-10 ml 3 times a day. RESULTS: Results: The patients in the control group were observed the decrease in intensity of rhinorrhea, nasal congestion and post-nasal drip on the third day of supervision (p < 0.05), the reduction in bacterial load with Staphylococcus aureus, S. pneumoniae, Haemophilus influenza and M. Catarrhalis (р <0,005), the increase of IgА and sIgA levels (p<0,005) and the reduction in prescription of antibacterial medications by 20%. CONCLUSION: Conclusions: Adding of polyvalent bacteriophage contributes to reducing the use of antibiotics and is recommended in the framework of the strategy of delayed prescribing of antibiotics.

Efficacy of a prepared tissue culture-adapted vaccine against Chlamydia psittaci experimentally in mice.

BACKGROUND AND AIM: Chlamydia psittaci is an intracellular pathogen with a broad range of hosts and endemic in nearly all bird species as well as many mammalian species. Outbreaks contribute to economic losses, especially due to infection of pet birds, poultry, and livestock. Worse, the organism has a zoonotic effect, and transmission to humans results in severe illness. Therefore, proper control measures need to be applied. We conducted a trial for the preparation and evaluation of inactivated vaccine against C. psittaci. MATERIALS AND METHODS: Three C. psittaci strains (accession nos.: KP942827, KP942828, and KP942829) were grown in embryonated chicken eggs and then propagated for purification in Vero cells. The immunization experiment was experimentally performed in mice, which then were challenged with a virulent C. psittaci strain. RESULTS: The immunization trial revealed nearly 100% protection after the challenge. The histopathological and immunofluorescence examinations of internal organs revealed that the prepared killed vaccines can effectively reduce chlamydial infection and shedding in animals with the proper level of protection. CONCLUSION: Our vaccine can be used to control economic and financial losses resulting from avian chlamydiosis, especially those in poultry industries. The zoonotic transmission risk highlights the need for proper control measures.

Detection and antibiotic resistance of Mycoplasma gallisepticum and Mycoplasma synoviae among chicken flocks in Egypt.

BACKGROUND AND AIM: Mycoplasma gallisepticum (MG) and Mycoplasma synoviae (MS) are the most significant pathogens of avian mycoplasmosis. This study aimed to isolate and identify MG and MS from chickens and detect the various virulence genes in the isolates. Moreover, the efficacies of different antibiotics were tested to identify suitable treatment regimens. MATERIALS AND METHODS: We isolated MG and MS from 487 chicken samples of different ages located in different Governorates in Egypt using conventional isolation methods. The isolates were characterized by polymerase chain reaction (PCR) and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and then tested for antibiotic sensitivity by the minimum inhibitory concentration (MIC) method. RESULTS: The prevalence of MG among the isolates was 9.85%, with the highest percentage isolated from air sacs, while the prevalence of MS among the isolates was 1.6%. Moreover, the highest levels of the prevalence of both MG and MS were during the winter and autumn sampling, while the lowest levels were in the summer and spring. Following the 16S rRNA-based detection of Mycoplasma isolates, 14 MG and 5 MS isolates were identified by different PCR-based detection methods for various virulence genes. Nine MG isolates contain the mgc2 gene, six MG isolates contain the gapA gene, and three MS isolates contain the vlhA gene. We validated a duplex PCR method for the simultaneous identification of MG and MS, based on 100% of the MG and MS isolates generating common bands at 55 and 17 kDa, respectively. The MIC method identified tiamulin and spiramycin as the antibiotics of choice for the treatment of MG and MS infections, respectively. CONCLUSION: For more precise diagnosis of Mycoplasma infections in chicken flocks, conventional isolation methods must be confirmed by PCR. SDS-PAGE analysis helps in epidemiological studies and vaccine preparation. The MIC method can be used to help develop therapies to control avian mycoplasmosis infections.

Challenges of providing healthcare worker education and training in protracted conflict: a focus on non-government controlled areas in north west Syria.

Without healthcare workers (HCWs), health and humanitarian provision in Syria cannot be sustained either now or in the post-conflict phase. The protracted conflict has led to the exodus of more than 70% of the healthcare workforce. Those remaining work in dangerous conditions with insufficient resources and a healthcare system that has been decimated by protracted conflict. For many HCWs, particularly those in non-government-controlled areas (NGCAs) of Syria, undergraduate education and postgraduate training has been interrupted with few opportunities to continue. In this manuscript, we explore initiatives present in north west Syria at both undergraduate and postgraduate level for physician and non-physician HCWs. Conclusion: Challenges to HCW education in north west Syria can be broadly divided into 1. Organisational (local healthcare leadership and governance, coordination and collaboration between stakeholders, competition between stakeholders and insufficient funding.) 2. Programmatic (lack of accreditation or recognition of qualifications, insufficient physical space for teaching, exodus of faculty affecting teaching and training, prioritisation of physicians over non-physicians, informally trained healthcare workers.) 3. Healthcare system related (politicisation of healthcare system, changing healthcare needs of the population, ongoing attacks on healthcare.) Locally implementable strategies including dedicated funding are key to supporting retention of HCWs and return during post-conflict reconstruction.

Genetic diversity of Salmonella enterica recovered from chickens farms and its potential transmission to human.

BACKGROUND: Salmonella is a zoonotic bacterium transmitted through the food chain and is an important cause of disease in humans. The current study is aimed to characterize Salmonella isolates from broiler breeder chickens farms using, polymerase chain reaction (PCR) and sequencing analysis of representative isolates. METHODS: S. Kentucky (n=11), S. Enteritidis (n=4), S. Typhimurium (n=3), S. Breanderp (n=1), and Sand S. Newport (n=1), were identified from chicken farms. Antimicrobial sensitivity test among the strains were investigated using 13 antibacterial discs. The amplified fragments of fliC and sefA genes were used to characterize S. Kentucky, S. Enteritidis and S. Typhimurium strains. Sequence analysis of the amplified PCR products for Salmonella Kentucky, Enteritidis and Typhimurium were carried out. RESULTS: Antimicrobial sensitivity testing revealed that 95% of the isolates were resistant to penicillin, 85% to norfloxacin and colistin sulfate (each), 75% to gentamicin, 70% to nalidixic acid and 60% to flumequine. The obtained sequences revealed the close identity of the isolated strains with other Salmonella reference strains in different countries. CONCLUSION: Analysis of the selected salmonellae confirm the report of Salmonella Enteritidis, Salmonella Typhimurium and Salmonella Kentucky circulation among broiler breeder flocks and the need to determine antibacterial susceptibility pattern regularly to detect multidrug-resistant salmonellae. The present study reports the circulation of Salmonella Kentucky, Enteritidis and Typhimurium among broiler breeder farms in Egypt. Emergency control of salmonellae is a global public health concern.

Isolation of antimicrobial producing Actinobacteria from soil samples.

Emergence of multidrug resistant bacteria has made the search for novel bioactive compounds from natural and unexplored habitats a necessity. Actinobacteria have important bioactive substances. The present study investigated antimicrobial activity of Actinobacteria isolated from soil samples of Egypt. One hundred samples were collected from agricultural farming soil of different governorates. Twelve isolates have produced activity against the tested microorganisms (S. aureus, Bacillus cereus, E. coli, K. pneumoniae, P. aeruginosa, S. Typhi, C. albicans, A. niger and A. flavus). By VITEK 2 system version: 07.01 the 12 isolates were identified as Kocuria kristinae, Kocuria rosea, Streptomyces griseus, Streptomyces flaveolus and Actinobacteria. Using ethyl acetate extraction method the isolates culture's supernatants were tested by diffusion method against indicator microorganisms. These results indicate that Actinobacteria isolated from Egypt farms could be sources of antimicrobial bioactive substances.

Occurrence of ampicillin-resistant Enterococcus faecium carrying esp gene in pet animals: An upcoming threat for pet lovers.

OBJECTIVES: This study was carried out to investigate oral colonisation by Enterococcus faecalis and Enterococcus faecium in pet dogs and cats, with special reference to antibiotic resistance. METHODS: Oral swabs were collected from 63 pet dogs and 57 pet cats with no known history of hospitalisation. All samples were enriched in Kenner Fecal (KF) broth before being cultured on KF agar to isolate enterococci. E. faecalis and E. faecium were identified by biochemical and molecular techniques. Antimicrobial resistance was determined by the disk diffusion method, and ampicillin-resistant strains were further examined by PCR to detect the esp gene. RESULTS: Oral prevalence rates of E. faecalis among pet dogs and cats were 3.2% and 5.3%, respectively, whilst those for E. faecium were 22.2% and 15.8%, respectively. None of the isolated enterococci were resistant to vancomycin. However, ampicillin-resistant E. faecium (AREfm) was detected in the examined dogs and cats at rates of 14.3% and 5.3%, respectively. Moreover, among the isolated enterococci, six isolates showed multidrug resistance (all AREfm). Whilst the esp gene was detected in only two of nine canine AREfm isolates (multidrug-resistant strains), none of feline AREfm isolates harboured esp. CONCLUSIONS: The occurrence of AREfm and the esp gene among oral isolates from pet dogs and cats represents a great public health hazard for pet owners and highlights possible zoonotic transmission of such a nosocomial pathogen outside healthcare facilities.

Results of a Nationwide Capacity Survey of Hospitals Providing Trauma Care in War-Affected Syria.

IMPORTANCE: The Syrian civil war has resulted in large-scale devastation of Syria's health infrastructure along with widespread injuries and death from trauma. The capacity of Syrian trauma hospitals is not well characterized. Data are needed to allocate resources for trauma care to the population remaining in Syria. OBJECTIVE: To identify the number of trauma hospitals operating in Syria and to delineate their capacities. DESIGN, SETTING, AND PARTICIPANTS: From February 1 to March 31, 2015, a nationwide survey of 94 trauma hospitals was conducted inside Syria, representing a coverage rate of 69% to 93% of reported hospitals in nongovernment controlled areas. MAIN OUTCOMES: Identification and geocoding of trauma and essential surgical services in Syria. RESULTS: Although 86 hospitals (91%) reported capacity to perform emergency surgery, 1 in 6 hospitals (16%) reported having no inpatient ward for patients after surgery. Sixty-three hospitals (70%) could transfuse whole blood but only 7 (7.4%) could separate and bank blood products. Seventy-one hospitals (76%) had any pharmacy services. Only 10 (11%) could provide renal replacement therapy, and only 18 (20%) provided any form of rehabilitative services. Syrian hospitals are isolated, with 24 (26%) relying on smuggling routes to refer patients to other hospitals and 47 hospitals (50%) reporting domestic supply lines that were never open or open less than daily. There were 538 surgeons, 378 physicians, and 1444 nurses identified in this survey, yielding a nurse to physician ratio of 1.8:1. Only 74 hospitals (79%) reported any salary support for staff, and 84 (89%) reported material support. There is an unmet need for biomedical engineering support in Syrian trauma hospitals, with 12 fixed x-ray machines (23%), 11 portable x-ray machines (13%), 13 computed tomographic scanners (22%), 21 adult (21%) and 5 pediatric (19%) ventilators, 14 anesthesia machines (10%), and 116 oxygen cylinders (15%) not functional. No functioning computed tomographic scanners remain in Aleppo, and 95 oxygen cylinders (42%) in rural Damascus are not functioning despite the high density of hospitals and patients in both provinces. CONCLUSIONS AND RELEVANCE: Syrian trauma hospitals operate in the Syrian civil war under severe material and human resource constraints. Attention must be paid to providing biomedical engineering support and to directing resources to currently unsupported and geographically isolated critical access surgical hospitals.

Leptospirosis in animals and human contacts in Egypt: broad range surveillance.

INTRODUCTION: Leptospirosis is a re-emerging zoonotic disease of humans and animals worldwide. The disease is caused by pathogenic species of the genus Leptospira. These organisms are maintained in nature via chronic renal infection of carrier animals, which excrete the organisms in their urine. Humans become infected through direct or indirect exposure to infected animals and their urine or through contact with contaminated water and soil. This study was conducted to investigate Leptospira infections as a re-emerging zoonosis that has been neglected in Egypt. METHODS: Samples from 1,250 animals (270 rats, 168 dogs, 625 cows, 26 buffaloes, 99 sheep, 14 horses, 26 donkeys and 22 camels), 175 human contacts and 45 water sources were collected from different governorates in Egypt. The samples were collected from different body sites and prepared for culture, PCR and the microscopic agglutination test (MAT). RESULTS: The isolation rates of Leptospira serovars were 6.9%, 11.3% and 1.1% for rats, dogs and cows, respectively, whereas the PCR results revealed respective detection rates of 24%, 11.3% and 1.1% for rats, dogs and cows. Neither the other examined animal species nor humans yielded positive results via these two techniques. Only six Leptospira serovars (Icterohaemorrhagiae, Pomona, Canicola, Grippotyphosa, Celledoni and Pyrogenes) could be isolated from rats, dogs and cows. Moreover, the seroprevalence of leptospiral antibodies among the examined humans determined using MAT was 49.7%. CONCLUSIONS: The obtained results revealed that rats, dogs and cows were the most important animal reservoirs for leptospirosis in Egypt, and the high seroprevalence among human contacts highlights the public health implications of this neglected zoonosis.

Leptospirosis in animals and human contacts in Egypt: broad range surveillance

INTRODUCTION: Leptospirosis is a re-emerging zoonotic disease of humans and animals worldwide. The disease is caused by pathogenic species of the genus Leptospira. These organisms are maintained in nature via chronic renal infection of carrier animals, which excrete the organisms in their urine. Humans become infected through direct or indirect exposure to infected animals and their urine or through contact with contaminated water and soil. This study was conducted to investigate Leptospira infections as a re-emerging zoonosis that has been neglected in Egypt. METHODS: Samples from 1,250 animals (270 rats, 168 dogs, 625 cows, 26 buffaloes, 99 sheep, 14 horses, 26 donkeys and 22 camels), 175 human contacts and 45 water sources were collected from different governorates in Egypt. The samples were collected from different body sites and prepared for culture, PCR and the microscopic agglutination test (MAT). RESULTS: The isolation rates of Leptospira serovars were 6.9%, 11.3% and 1.1% for rats, dogs and cows, respectively, whereas the PCR results revealed respective detection rates of 24%, 11.3% and 1.1% for rats, dogs and cows. Neither the other examined animal species nor humans yielded positive results via these two techniques. Only six Leptospira serovars (Icterohaemorrhagiae, Pomona, Canicola, Grippotyphosa, Celledoni and Pyrogenes) could be isolated from rats, dogs and cows. Moreover, the seroprevalence of leptospiral antibodies among the examined humans determined using MAT was 49.7%. CONCLUSIONS: The obtained results revealed that rats, dogs and cows were the most important animal reservoirs for leptospirosis in Egypt, and the high seroprevalence among human contacts highlights the public health implications of this neglected zoonosis. .

Sequencing analysis of Mycoplasma gallisepticum wild strains in vaccinated chicken breeder flocks.

Mycoplasma gallisepticum (MG) infection is still of continuing economic concern in commercial broiler breeder chicken flocks in Egypt. MG infection continues to emerge despite the application of vaccination programs in breeder flocks. This prompted flock surveillance including MG isolation and molecular characterization of the circulating MG strains. The present study was concerned with 15 broiler breeder flocks of different ages (5-51 weeks). Three flocks were apparently healthy and 12 flocks were diseased. The aim of the study was to characterize the MG strains recovered from tracheal swabs. Four positive MG DNA extracts identified by rt-PCR and confirmed by isolation were subjected to sequencing of the mgc2 gene and intergenic spacer region (IGSR). The current molecular study demonstrated the presence of 3 different wild-type MG strains (RabE1-08, RabE2-09 and RabE3-09) in vaccinated diseased flocks, while the fourth strain (RabE4-08), which was isolated from a nonvaccinated apparently healthy breeder flock, scored 100% of homology and similarity to the F-strain vaccine by the sequence analysis of mgc2 and IGSR. It can be assumed that the vaccine F strain, which is supposed to replace field strains not only failed to do that, but also infected nonvaccinated flocks. Accordingly, there is a need to revise the control program including vaccine strategy in parallel with biosecurity measures.