COVID-19 fatality and DALYs, and associated metabolic disorders and ambient air pollutants in pre-Omicron era of the pandemic: an international comparative study.

BACKGROUND: Air pollution and a number of metabolic disorders have been reported to increase the risk of severe COVID-19 outcomes. This study explored the association between severe COVID-19 outcomes, metabolic disorders and environmental air pollutants, at regional level, across 38 countries. METHODS: We conducted an ecological study using COVID-19 data related to countries of the Organization for Economic Cooperation and Development (OECD), with an estimated population of 1.4 billion. They were divided into 3 regions: 1. Europe & Middle east; 2. Americas (north, central & south America); 3. East-Asia & West Pacific. The outcome variables were: COVID-19 case-fatality rate (CFR) and disability-adjusted life years (DALYs) at regional level. Freely accessible datasets related to regional DALYs, demographics and other environmental pollutants were obtained from OECD, WHO and the World in Data websites. Generalized linear model (GLM) was performed to determine the regional determinants of COVID-19 CFR and DALYs using the aggregate epidemiologic data (Dec. 2019-Dec. 2021). RESULTS: Overall cumulative deaths were 65,000 per million, for mean CFR and DALYs of 1.31 (1.2)% and 17.35 (2.3) years, respectively. Globally, GLM analysis with adjustment for elderly population rate, showed that COVID-19 CFR was positively associated with atmospheric PM2.5 level (beta = 0.64(0.0), 95%CI: 0.06-1.35; p < 0.05), diabetes prevalence (beta = 0.26(0.1), 95%CI: 0.12-0.41; p < 0.001). For COVID-19 DALYs, positive associations were observed with atmospheric NOx level (beta = 0.06(0.0), 95%CI: 0.02-0.82; p < 0.05) and diabetes prevalence (beta = 0.32(0.2), 95%CI: 0.04-0.69; p < 0.05). At regional level, adjusted GLM analysis showed that COVID-19 CFR was associated with atmospheric PM2.5 level in the Americas and East-Asia & Western Pacific region; it was associated with diabetes prevalence for countries of Europe & Middle east and East-Asia & Western Pacific region. Furthermore, COVID-19 DALYs were positively associated with atmospheric PM2.5 and diabetes prevalence for countries of the Americas only. CONCLUSION: These findings confirm that diabetes and air pollution increase the risk of disability and fatality due to COVID-19, with disparities in terms of their impact. They suggest that efficient preventive and management programs for diabetes and air pollution countermeasures would have curtailed severe COVID-19 outcome rates.

Profiles of sugar fermenting bacteria of the oral cavity among children with dental caries attending stomatology services at Ruhengeri referral hospital in Musanze District, Northern Rwanda.

Background: Dental caries remains a public health threat of concern among children. About 2.3 billion people are affected by dental caries, of which 530 million are children globally. Objective: This study was carried out to identify sugar fermenting bacteria in the oral cavity and their antibiotic susceptibility pattern, assess the association with sugar fermenter bacteria and dental caries and evaluate dental caries outcomes among children. Materials and Methods: This was a cross-sectional study conducted between October 2021 and February 2022 at Ruhengeri Referral Hospital. About 136 oral swab samples were collected from children with and without dental caries at 1:1 ratio. The samples were put in Stuart sterile container and transported to INES-clinical microbiology laboratory for microbial identification. Logistic regression analysis of demographic characteristics was performed to study the relationship between demographic variables and dental caries. Chi-square test was performed for the association between variables. Results: About 67.6% were male, while children of age 7-9 years (64.7%) dominated the age groups. Lactobacilli spp (15.29%) and Streptococcus mutans (12.94%) were the most predominant microorganisms observed in the oral cavity among children with dental caries. The S. mutans (x2 = 27.03, P < 0.00001, 95% confidence interval [CI]=0.2901-0.5785), S. aureus (x2 = 34.59, P < 0.00001, 95% CI = 0.3541-0.6292), Enterobacter aerogenes (x2 = 13.5, P = 0.000239, 95% CI = 0.151-0.4622), Serratia marcescens (x2 = 11.64, P = 0.00645, 95% CI = 0.1275-0.4418) and Klebsiella pneumonia (x2 = 13.51, P = 0.000237, 95% CI = 0.1511-0.4623) were significantly associated with dental caries. Teeth loss (x2 = 51.04, P < 0.00001, 95% CI = 0.4757-0.7205), teeth pain (x2 = 5.05, P = 0.0246, 95% CI = 0.0249-0.33499), and infection (x2 = 4.73, P = 0.02964, 95% CI = 0.0186-0.3441) were dental outcomes associated with tooth decay. Ciprofloxacin, clindamycin, and amoxicillin were the most sensitive antibiotics, while vancomycin and chloramphenicol were the most resistant. Conclusion: Sugar consumption favours the growth of sugar fermenter bacteria that cause dental caries among children. Dental caries is associated with adverse oral health outcomes among children. Oral health education is recommended for children. Parents are advised to reduce the consumption of sugary food for their children for oral health safety.

Contribution of Medical Wards Contamination to Wound Infection among Patients Attending Ruhengeri Referral Hospital.

Nosocomial infections or hospital-acquired infections are infections that potentially occur in the patients under medical care. These infections are often caused by multidrug-resistant pathogens acquired via improper antibiotic use, not following infection control and prevention procedures. The main objective of this study was to investigate the contribution of medical wards contamination to wound infection and antibiotics susceptibility patterns at Ruhengeri Referral Hospital, Musanze district, Rwanda. This was a cross-sectional study where a total of 61 samples including air sampling to evaluate the contamination by airborne bacteria, working surface, equipment, and patients' surgical wounds swabs were collected in intensive care unit (ICU), pediatrics, and surgery departments. Culture, Gram stain, and biochemical tests were performed for microbiological isolation and identification. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method. Statistical Package for Social Science (SPSS) version 22 was used for data analysis. Gram-negative bacteria were frequently from surgery, pediatric, and ICU with 68.8%, 63.9%, and 31.1%, respectively, while Gram-positive isolates were 37.7% in surgery, 32.9% in pediatric, and 18.0% in ICU. There was a statistically significant association with E. coli and swabbed materials and surgical wound sites (x 2 = 10.0253, P value = 0.018). All bacterial contaminants were sensitive to clindamycin and erythromycin. Pseudomonas aeruginosa, E. coli, and S. aureus were resistant to nitrofurantoin. Hospital environment could be a contributing factor to surgical wound site infections. Hospitals should apply preventive measures in the hospital environment surrounding wound surgery patients to prevent wound infections during hospital stay.

Bacteriological Study of Electronic Devices Used by Healthcare Workers at Ruhengeri Referral Hospital.

Electronic devices have become one of the most essential accessories being used in hospitals. Those devices increase the communication and contact making healthcare delivery more efficient and quality service oriented. The study was designed to collect reliable information about the spreading of pathogens through electronic devices especially in sensitive departments. The objectives of this study were to evaluate the bacterial colonization of electronic devices and determine the effectiveness of disinfection with alcohol 70% (w/v) to reduce the bacterial colonization of electronic devices. It was a cross-sectional study where samples were collected by means of moistened swabs in sterile saline solution from 30 electronic devices used by healthcare workers at Ruhengeri Referral Hospital within four different units: maternity, neonathology, intensive care, and theater room. To evaluate the effects of disinfection using 70% isopropyl alcohol, the second sample collection was carried out after decontamination with 70% isopropyl alcohol. Samples were analyzed in the microbiology lab of INES-Ruhengeri. The result showed that Staphylococcus aureus was the most predominant with 22.5%. Lactobacillus and Citrobacter spp. were 12.5%; Pseudomonas aeruginosa, coagulase-negative Staphylococci, and Serratia marcescens were 10%; Escherichia coli was 7.5%; Klebsiella spp. and Providencia spp. were at 5%. The lowest prevalence was 2.5% of Enterobacter spp. and Salmonella spp. The threat of dissemination of isolated microorganisms is valid, since all devices evaluated in this study showed bacterial contamination of species associated to hospital-acquired infections. Special care should be taken when using electronic devices in healthcare settings in addition to disinfection to reduce the risk of transmission of bacterial agents. Further studies should evaluate the antibiotic susceptibility for better conclusive results since all isolated bacteria in this study were subjected to high resistance and were associated with nosocomial infections.