Characterization and Antimicrobial Susceptibility Patterns of Enterococcus Species Isolated from Nosocomial Infections in a Saudi Tertiary Care Hospital over a Ten-Year Period (2012-2021).

INTRODUCTION: The Enterococcus genus is a common cause of nosocomial infections, with vancomycin-resistant enterococci (VRE) posing a significant treatment challenge. METHOD: This retrospective study, spanning ten years (2012 to 2021), analyzes antimicrobial susceptibility patterns of Enterococcus species from clinical samples in a Saudi Arabian tertiary care hospital. RESULT: A total of 1034 Enterococcus isolates were collected, 729 from general wards and 305 from intensive care unit (ICU) patients. VRE accounted for 15.9% of isolates. E. faecalis was the most common species (54.3% of isolates and 2.7% of VRE), followed by E. faecium (33.6% of isolates and 41.2% of VRE). E. faecium exhibited the highest resistance to ciprofloxacin (84.1%), ampicillin (81.6%), and rifampicin (80%), with daptomycin (0.6%) and linezolid (3.1%) showing the lowest resistance. In E. faecalis, ciprofloxacin resistance was highest (59.7%), followed by rifampicin (20.1%) and ampicillin (11.8%). Daptomycin (0%), linezolid (1.5%), and vancomycin (2.7%) had the lowest resistance. VRE cases had higher mortality rates compared to vancomycin-sensitive enterococci (VSE). CONCLUSION: Eight different strains of Enterocci were identified. E. faecalis was the most commonly identified strain, while E. faecium had the highest percentage of VRE. VRE cases had a significantly higher mortality rate than VSE cases.

Vagal Nerve Stimulation in the Pediatric Population and Correlation Between Family and Treatment Team Perspectives: Single-center Experience.

BACKGROUND: Vagal nerve stimulation (VNS) is an adjunctive therapy to pharmacological treatment in patients with drug-resistant epilepsy. This study aimed to assess the efficacy of VNS therapy for seizure frequency reduction and improving quality of life (QOL) measures in children with refractory epilepsy and to evaluate the correlation between the perspectives of families and those of the treating team. METHODS: This was a prospective cohort study conducted at Abha Maternity and Children's Hospital, Saudi Arabia, from 2018 to 2022. A total of 21 pediatric patients who completed one year of follow-up after VNS implantation were included. Patients were aged between 2 and 14 years, with a mean age of 8.14 ± 3.92; 11 (52.4%) patients were female. Family and physician assessments were collected blinded to each other using Clinical Global Impression of Improvement (CGI-I) scores and QOL assessments to evaluate the correlation between the families' and treating team's perspectives on VNS outcomes. RESULTS: In this study involving 21 patients with intractable epilepsy, VNS showed significant efficacy in reducing the frequency of seizures. VNS significantly reduced the number of seizures per week from a baseline median of 35 to a median of 0.25 at the end of the follow-up period, representing a dramatic reduction of 99.3% (p < 0.001). The number of emergency department visits per year decreased from a baseline median of 12 to a median of 2, a reduction of 83.3% (p < 0.001), whereas the number of hospital admissions per year decreased from a baseline median of 3 to a median of 1, a 66.7% decrease (p < 0.001). The number of antiepileptic medications taken decreased from a median of 4 to 3 (p < 0.001). Notably, 28.57% of the patients achieved complete seizure freedom, and 38% exhibited significant improvement, with at least 50% reduction in seizure frequency. Importantly, none of the patients experienced an escalation in seizure frequency following VNS treatment. The family and physician assessments showed varying degrees of alignment in perceptions, with "concentration" exhibiting a significant positive correlation (r = 0.498, p = 0.022), indicating noteworthy agreement, whereas verbal communication did not show a substantial correlation (r = -0.062, p = 0.791), indicating a divergence of views. CONCLUSION: VNS is a promising and well-tolerated therapy for individuals with intractable seizures, offering clinical benefits and potential enhancements in various aspects of QOL. The varying perceptions between family and physician assessments highlight the importance of considering multiple perspectives when evaluating treatment outcomes.

Diagnostic Evaluation of Polycythemia Vera at High Altitude.

BACKGROUND: Polycythemia is a common medical problem, frequently acquired and reactive to secondary conditions. High-altitude-associated hypoxia contributes to the greater prevalence of polycythemia at altitude. Primary clonal polycythemia vera (PV), even though it is rare, requires a different therapeutic approach. Suspicion of PV usually drives the diagnostic workup of polycythemia. METHODS: In this retrospective lab record study, we collected all JAK2 tests requested over a three-year period. We analyzed requests that were made for the evaluation of polycythemia. Complete blood count (CBC) and imaging of the abdomen were collected. RESULTS: Out of 208 total requests, 136 were for the purpose of polycythemia evaluation. JAK2 mutation was positive (confirming the presence of PV) in 22 (16.7%) cases. PV patients have the usual demographics reported elsewhere. Additionally, PV patients exhibit distinct hemogram results featuring leukocytosis, thrombocytosis, and hypochromic microcytic red blood cells (RBCs) related to the associated iron deficiency. CONCLUSIONS: Many patients with polycythemia at altitude might be unnecessarily considered for an evaluation of PV, if hemoglobin/hematocrit is the sole deciding criterion. PV patients have a distinct CBC pattern that can be exploited to better select patients with polycythemia for further evaluation and thus reduce unnecessary workups.

Avoidable emergency department visits among palliative care cancer patients: novel insights from Saudi Arabia and the Middle East.

BACKGROUND: Several studies emerging from developed countries have highlighted a significant number of potentially avoidable emergency department (ED) visits by cancer patients during the end-of-life period. However, there is a paucity of information from developing nations regarding palliative care practices and the utilization of the ED by palliative care patients. Herein, we aim to characterize ED admissions among patients receiving palliative care at our tertiary center in Saudi Arabia. METHODS: This is a retrospective, cross-sectional study evaluating ED visits amongst adult patients with advanced cancer who were receiving treatment under the palliative care department. This study took place over a period of 12 months from July 2021 through to July 2022. Three palliative care specialist physicians independently and blindly reviewed each patient's ED visits and determined whether the visit was avoidable or unavoidable. RESULTS: A total of 243 patients were included in the final analysis, of which 189 (78.1%) patients had unavoidable visits and 53 (21.9%) patient visits were classified as avoidable. A significantly higher proportion of breast cancer patients presented with unavoidable admissions (14.3% vs. 3.8%, P = 0.037) compared to other cancer types. The incidence of dyspnea (23.8% vs. 5.7%, P < 0.001) and fevers/chills (23.3% vs. 5.7%, P = 0.005) was significantly higher in patients with unavoidable visits. Patients with avoidable visits had a significantly greater proportion of visits for dehydration (13.2% vs. 2.1%, P = 0.002). Notably, although hospital stay was significantly longer in the unavoidable group (P = 0.045), mortality for palliative care patients-regardless of whether their ED visit was avoidable or unavoidable-was not statistically different (P=-0.069). CONCLUSION: To our knowledge, this is the largest and most comprehensive study from Saudi Arabia and the Middle East providing insights into the utilization of palliative care services in the region and the propensity of advanced cancer patients towards visiting the ED. Future studies ought to explore interventions to reduce the frequency of avoidable ED visits.

Prognostic accuracy of qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients presenting with suspected infection to the emergency department (PASSEM) Multicenter prospective external validation cohort study protocol.

BACKGROUND: Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). We aim to externally validate qSOFA, SIRS, and NEWS/NEWS2/MEWS for in-hospital mortality among adult patients with suspected infection who presenting to the emergency department. METHODS AND ANALYSIS: PASSEM study is an international prospective external validation cohort study. For 9 months, each participating center will recruit consecutive adult patients who visited the emergency departments with suspected infection and are planned for hospitalization. We will collect patients' demographics, vital signs measured in the triage, initial white blood cell count, and variables required to calculate Charlson Comorbidities Index; and follow patients for 90 days since their inclusion in the study. The primary outcome will be 30-days in-hospital mortality. The secondary outcome will be intensive care unit (ICU) admission, prolonged stay in the ICU (i.e., ≥72 hours), and 30- as well as 90-days all-cause mortality. The study started in December 2021 and planned to enroll 2851 patients to reach 200 in-hospital death. The sample size is adaptive and will be adjusted based on prespecified consecutive interim analyses. DISCUSSION: PASSEM study will be the first international multicenter prospective cohort study that designated to externally validate qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients with suspected infection presenting to the ED in the Middle East region. STUDY REGISTRATION: The study is registered at ClinicalTrials.gov (NCT05172479).

The Epidemiological Pattern of Skin Cancer from 2011 to 2022 among the Population of the Aseer Region, Kingdom of Saudi Arabia.

The overall risk of developing cancer before the age of 75 years in the Kingdom of Saudi Arabia is 9.9%. We aimed to explore the pattern of skin cancer, specifically among the Saudi population residing in the Aseer region. We obtained data from the medical records of Aseer Central Hospital regional histopathological laboratory considering surgical pathology reports from 2011 to 2021. The 61-80-year-old age group represented most of the cases (41.4%), followed by the 41-60-year-old group at 24.1%. Men made up the majority of the cases (59.4%). Furthermore, the dataset predominantly consisted of Saudi nationals (94.3% of the sample). The percentage of cases diagnosed each year relative to the cumulative number of skin cancer cases varied each year, ranging from 1.6% in 2011 to 11.6% in 2017. The most common diagnoses were squamous cell carcinoma (SCC) with 230 cases (41.1%) and basal cell carcinoma (BCC) with 147 cases (26.3%). The majority of cases occurred in the head and neck region (55.4%), followed by the lower limb (16.6%), trunk (13.6%), upper limb (8.2%), and pelvis (2.3%). There was a significant variation in the type of skin cancer across the age groups (p < 0.001) and across different body parts (p < 0.001). The incidence of skin cancer exhibited variability throughout the study period. The predominant diagnoses observed were SSC and BCC. Among the affected areas, the head and neck region displayed the highest prevalence, followed by the lower limb, trunk, upper limb, and pelvis.

Risk Factors for Postoperative Infections in Cardiac Surgery Patients: A Retrospective Study.

Background and objective Cardiac surgery is one of the most common surgical procedures globally; its incidence has been on the rise due to the faster pace of population aging thanks to technological and epidemiological advances. Patients who undergo cardiac surgeries may face various postoperative complications that might affect their survival, and one of these major complications is infection. Nosocomial pneumonia, surgical site infection (SSI), mediastinitis, bacteremia, and sepsis are common infections encountered after surgeries. In this study, we aimed to determine the common risk factors related to postoperative infections at the King Faisal Cardiac Center from January 2014 to September 2020. Materials and methods  Records from 364 patients who underwent cardiac surgery and were aged above 18 years were assessed for postoperative infections in this retrospective cohort study. Patients who were immunosuppressed or had active systemic infections were excluded. Consent was waived by the Institutional Review Board. All procedures were performed at the King Faisal Cardiac Center, National Guard Hospital, Jeddah. Results Of the total 364 patients, 105 were women and 259 were men. The mean age of the cohort was 59 years (SD = 13) and the mean BMI was 29.1 kg/m2 (SD = 5.3). The study population showed a high prevalence of cardiac risk factors and diseases: diabetes (n = 244, 67%), hypertension (n = 230, 63%), dyslipidemia (n = 144, 40%), smoking (n = 80, 22%), heart failure (n = 41, 11%), and chronic obstructive pulmonary disease (n = 6, 1.6%). The overall rate of postoperative infection was 32.7% (n = 120), and 17 (14%) of these infected patients underwent reoperations for infection. Conclusion Based on a thorough analysis of 364 patients undergoing various cardiac surgical procedures, including a multivariate analysis accounting for preoperative factors, there was a significant association between postoperative infections and hypertension, diabetes, increased preoperative activated partial thromboplastin time, and elevated HbA1c.

Awareness of chronic obstructive pulmonary disease (COPD) among the general population in Aseer Region, Kingdom of Saudi Arabia (KSA).

Background: Chronic obstructive pulmonary disease (COPD) is a common but preventable disease and has a prevalence of 5%-14% in the general population. It is characterized by airflow limitation and persistent respiratory symptoms. In this survey, we aimed to assess the awareness of COPD among the general population in the Aseer Region of the Kingdom of Saudi Arabia (KSA). Method: This was an observational, cross-sectional study in which predesigned electronic questionnaires were distributed to 504 randomly selected community personnel utilizing phone services. The collected data were analyzed using the IBM SPSS Statistics software, version 24 for Windows (IBM Corp., Armonk, NY). Results: Participants were asked 11 questions with yes-or-no answers based on awareness and symptoms of COPD: 35.5% of participants had heard about the COPD as a term and 72% had no detailed information about COPD. Only 3.5% of participants had relatives with COPD. During the survey on COPD symptoms, 31% of participants chose shortness of breath and the rest chose cough (20%), sputum production (15%), wheezing (14%), and chest pain (19%). Almost two-third of the participants had no idea about COPD symptoms. For the most disease knowledge, majority of the study participants had very poor knowledge about the disease that was evident in the 22 questions intended to assess this domain. Social media sites ranked as the most popular source of information on COPD among the study participants. Conclusion: Awareness about COPD among the general population in the Aseer Region in KSA is poor. It is advisable to carry out programs to increase their level of awareness.

The attitude of the Public Toward Social History Taking in Southern Saudi Arabia.

Background: Social history taking is an important element of a medical interview. No previous studies, however, addressed public attitudes regarding social history taking in Saudi Arabia. Objective: This study explores public attitudes about the importance of social history taking by doctors in Southern Saudi Arabia. Methods: A cross-sectional study was conducted to collect public opinion about social history taking using a self-administered questionnaire. Social history taking was defined as questions about general sociodemographics (job, income, marital status, housing conditions, and animal contact) and social habits (travel, smoking, alcohol drinking, illicit drug use, and sexual history). Descriptive statistics were conducted, along with a comparison between categorical variables. Results: A total of 510 respondents completed the questionnaire, of which 381 (74.7%) had a medical history taken before. A complete social taking was not obtained from those with medical history previously taken. Marital status (73.2%), smoking (49.1%), and occupation (32.8%) were the commonest inquiries, while income (3.7%) and sexual history (6.6%) were the least. Most respondents had no reservations about answering questions about their social history. Among the general demographic questions, job and marital status were more likely to be answered, whereas income and housing inquiries were less likely to be answered. Among social habits, sexual history followed by illicit drug use and alcohol drinking inquiries were less likely to be answered. Conclusion: Detailed social history taking is uncommon among doctors. The public is open to discussing their social status and habits. However, questions involving income, housing, and some social habits like illicit drugs, alcohol, and sexual history are less likely to be faithfully reported and thus need to be handled appropriately. It is crucial for healthcare providers to approach social history taking with sensitivity and respect and to create a private environment for patients where they can freely and accurately share their social histories.

The microbiological profile of isolates recovered from ICU patients with traumatic brain injuries at a tertiary care center, Southern Region, Saudi Arabia.

INTRODUCTION: Traumatic head injury THI is a Neurosurgical condition in which brain function is interrupted as a result of blunt (motor vehicle accidents MVA, falls, and assaults) or penetrating trauma. Nearly half of all injuries are caused by head trauma. Head traumas are a leading cause of death and organ loss in young people, where this population accounts for the vast majority of TBI patients. METHODOLOGY: This retrospective cohort study was conducted at Asir Central Hospital, KSA with data from 2015 to 2019. Records of bacterial cultures and outcomes such as length of stay in the hospital were analyzed. In addition, treatment outcomes were also analyzed. RESULTS: A total of 300 ICU patient samples (69 patients) were included. Patients' ages ranged from 13 to 87 years with a mean age of 32.4 ± 17.5 years old. The most frequently reported diagnosis was RTA (71 %), followed by SDH (11.6 %), The most isolated organisms from the recovered samples were Klebsiella pneumoniae (27 %), followed by Pseudomonas aeruginosa (14.7 %). Regarding susceptibility, Tigecycline was the most sensitive (44 %), followed by Gentamicin (43.3 %). A total of 36 (52.2 %) patients stayed for less than one month, 24 (34.8 %) stayed for 1-3 months, and 7 (10.1 %) stayed for 3-6 months. The mortality rate in our study population was (40.6 %) as 28 patients died. CONCLUSION: The prevalence of pathogens in TBI needs to be determined in different institutions for the establishment of effective empiric antibiotic treatment following infections in traumatic brain injuries. This will ultimately help to improve treatment outcomes. In neurosurgical patients undergoing cranial procedures after trauma, a hospital-standardized antibiotic policy is effective in achieving low rates of bacterial infections especially MDR infections.

Generalized morphea following COVID-19 vaccine: Case report and literature review.

Physicians should be vigilant for COVID-19 vaccine side effects and investigate any associated cutaneous manifestations. This will ultimately facilitate better understanding and recognition of various skin reactions related to the vaccine.

A 20-Year-Old Gossypiboma Causing Small Bowel Obstruction.

Retained foreign bodies including gossypiboma could be silent for years. However, in some cases, it can lead to major complications. Gossypiboma is not frequently reported for multiple reasons, including nonspecific presentation clinically and radiologically, and ethical issues. We present a case of a gossypiboma that was retained for more than 20 years causing a severe intestinal obstruction for an elderly female. The intestinal obstruction was initially thought to be adhesive in nature and was managed initially conservatively, but with failure to improve, the patient was taken for exploratory laparotomy, and the foreign body was found attached to the root of the mesentery posterior to the transverse colon. This case sheds light on the fact that although surgical tools are of great utility, they must be managed with utmost care to prevent complications and secure patients' safety.

A security testing mechanism for detecting attacks in distributed software applications using blockchain.

Distributed software applications are one of the most important applications currently used. Rising demand has led to a rapid increase in the number and complexity of distributed software applications. Such applications are also more vulnerable to different types of attacks due to their distributed nature. Detecting and addressing attacks is an open issue concerning distributed software applications. This paper proposes a new mechanism that uses blockchain technology to devise a security testing mechanism to detect attacks on distributed software applications. The proposed mechanism can detect several categories of attacks, such as denial-of-service attacks, malware and others. The process starts by creating a static blockchain (Blockchain Level 1) that stores the software application sequence obtained using software testing techniques. This sequence information exposes weaknesses in the application code. When the application is executed, a dynamic blockchain (Blockchain Level 2) helps create a static blockchain for recording the responses expected from the application. Every response should be validated using the proposed consensus mechanism associated with static and dynamic blockchains. Valid responses indicate the absence of attacks, while invalid responses denote attacks.

The association between preoperative anemia, blood transfusion need, and postoperative complications in adult cardiac surgery, a single center contemporary experience.

BACKGROUND: The impact of preoperative anemia on postcardiac surgery outcomes is an area of great debate. Although several large-scale studies have been conducted, they have demonstrated conflicting results. A limited number of studies have been conducted in the Middle East. The primary aim of this study was to investigate the association between preoperative anemia and the need for blood transfusions, as well as major postoperative complications. METHODS: Adult patients who underwent cardiac surgery at King Faisal Cardiac Center in Jeddah between June 2016 and January 2020 were included in this retrospective cohort study. The study excluded patients with hereditary preoperative anemia. Among the variables studied were variables related to demographics, comorbidities, laboratory data, operation-related data, in-hospital complications, and mortality. RESULTS: The mean preoperative hemoglobin (Hb) level was 13.2 g/dL (SD ± 1.8). The overall mortality rate was 4.6%. A lower preoperative Hb level (p value = 0.016), postoperative day 1 WBC count (p-value = 0.003), and prolonged cross clamp time (p value < 0.001) were significantly associated with mortality. A lower Hb level during the preoperative period or within the first three days of surgery was associated with a higher blood transfusion requirement. However, there was no significant association between blood transfusion and postoperative complications. A multivariate stepwise logistic regression model was developed and several pre and intra operative factors were predictive of the need PRBCs transfusion after cardiac surgery (which included: older age, female gender, lower pre-operative hemoglobin and longer cardio-pulmonary bypass time), with had a predictive accuracy of around ~ 86%. CONCLUSION: Based on our single center study, patients with preoperative lower Hb levels are at higher risk of mortality. However, blood transfusion does not seem to increase the risk of postoperative complications. Optimal utilization of blood products is an important quality metric and identification of patients at higher risk of requiring PRBCs transfusion prior to cardiac surgery can help in implementing pre or intra operative strategies to minimize the need for transfusion.

Study to determine the epidemiology of treatment-resistant depression among the Saudi Arabian population: A cross-sectional study.

BACKGROUND: Depression is a common mental health disorder that affects millions of people worldwide. Globally, major depressive disorder (MDD) is a public health concern; nearly, it affects more than 300 million people. The coronavirus disease 2019 (COVID-19) pandemic lockdown, travel restrictions, social distancing, and COVID-19 vaccine acceptance have aggravated psychological disorders, such as depression and suicidal tendencies. Treatment-resistant depression (TRD) is typically defined as a lack of response to at least two different antidepressant medications or psychotherapies. TRD is common and has been associated with higher comorbidities and prolonged duration of illness, leading to a substantial medical and economic burden. MATERIALS AND METHODS: A cross-sectional study was designed to determine the epidemiology and estimate the prevalence of TRD in Abha City, Assir Region, Kingdom of Saudi Arabia. The study includes adult patients who were attended to the psychiatry department and aged 18-65 years diagnosed with major depressive depression. A total of 651 study participants were recruited. RESULTS: Of the total 651 depressive disorder cases, 134 (20.6%) were reported as TRD and the remaining 517 (79.4%) were nontreatment-resistant depressive cases. Of the 651 depression participants, 176 (27%) were males and 475 (73%) were females. More than one-quarter (180 (28%)) had been associated with chronic morbidity. One-tenth of the depressive patients were suffering from thyroid disorders, followed by hypertension (10%), autoimmune diseases (10%), and diabetes mellitus (8%). CONCLUSIONS: TRD emerged as a threat to public health and challenging psychiatric care providers, and further innovative techniques and effective newer drugs to treat depression need to be researched. The treatment complaint mechanism is warranted, encouraging people to get treatment from the psychiatrist by removing the stigma of mental illness, which is needed to improve the quality of life of TRD patients.

Miniaturized Folded-Slot CubeSat MIMO Antenna Design with Pattern Diversity.

In this paper, a folded slot-based multiple-input-multiple-output (MIMO) antenna design for Cube Satellite (CubeSat) applications is presented for the ultra-high frequency (UHF) band. A unique combination of a reactively loaded meandered slot with a folded structure is presented to achieve the antenna's miniaturization. The proposed antenna is able to operate over a wide frequency band from 430~510 MHz. Moreover, pattern diversity is achieved by the antenna's element placement, resulting in good MIMO diversity performance. The four elements are placed on one Unit (1U) for CubeSat dimensions of 100 mm × 100 mm × 100 mm. The miniaturized antenna design with pattern diversity over a wide operating band is well suited for small satellite applications, particularly CubeSats in the UHF band.

Voriconazole- induced severe hypokalemic rhabdomyolysis: A case report.

We report a child who presented with lower limb weakness and inability to walk, laboratory confirmed severe hypokalemia with typical electrocardiogram changes, and evidence of rhabdomyolysis while on voriconazole treatment for Pseudallescheria boydii soft tissue infection. Although voriconazole is a well-tolerated antifungal agent, hypokalemia is a well-known, yet uncommon side effect associated with its use. Furthermore, hypokalemic-rhabdomyolysis has not been reported with voriconazole use alone. Maintaining the clinical suspicion about the potential association between voriconazole and hypokalemic-rhabdomyolysis can lead to prompt recognition and intervention.

Antibiotic prophylaxis for corneal abrasion.

BACKGROUND: Corneal abrasion is a common disorder frequently faced by ophthalmologists, emergency physicians, and primary care physicians. Ocular antibiotics are one of the management options for corneal abrasion. A comprehensive summary and synthesis of the evidence on antibiotic prophylaxis in traumatic corneal abrasion is thus far unavailable, therefore we conducted this review to evaluate the current evidence regarding this important issue. OBJECTIVES: To assess the safety and efficacy of topical antibiotic prophylaxis following corneal abrasion. Our objectives were 1) to investigate the incidence of infection with antibiotics versus placebo or alternative antibiotics in people with corneal abrasion; and 2) to investigate time to clinical cure, defined as complete healing (re-epithelialization) of the epithelium, with antibiotics versus placebo or alternative antibiotics in people with corneal abrasion. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 4), Ovid MEDLINE, Embase.com, PubMed, the Latin American and Caribbean Health Sciences Literature database (LILACS), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 25 April 2021. SELECTION CRITERIA: We included randomized controlled trials (RCTs) comparing antibiotic with another antibiotic or placebo in children and adults with corneal abrasion due to any cause. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology and assessed the certainty of the body of evidence for the prespecified outcomes using the GRADE classification. MAIN RESULTS: Our search of the electronic databases yielded 8661 records. We screened 7690 titles and abstracts after removal of duplicates. We retrieved 32 full-text reports for further review. We included two studies that randomized a total of 527 eyes of 527 participants in the review. One study was conducted in Denmark, and one was conducted in India. The two studies did not examine most of our prespecified primary and secondary outcomes. The first study was a parallel-group RCT comparing chloramphenicol ocular ointment with fusidic acid ocular gels (frequency was not clearly reported). This study enrolled 153 participants older than 5 years of age with corneal abrasion in Denmark with a one-day follow-up duration. No participants had secondary infection in the fusidic acid group, whereas three (4.1%) participants in the chloramphenicol group had a slight reaction (risk ratio [RR] 0.15, 95% confidence interval [CI] 0.01 to 2.79; 144 participants; very low certainty evidence). Thirty-one (44.3%) participants in the fusidic acid arm and 34 (46.6%) participants in the chloramphenicol arm were cured (defined as the area of abrasion zero and no infection) at day 1 (RR 0.94, 95% CI 0.65 to 1.34; 144 participants; very low certainty evidence). Without providing specific data, the study reported that the degree of pain was not affected by the interventions received. The most common adverse events reported were itching and discomfort of the eye, which occurred in approximately one-third of participants in each group (low certainty evidence). A second multicenter, two-arm RCT conducted in India enrolled 374 participants older than 5 years of age with corneal abrasion who presented within 48 hours after injury. This study investigated the effect of a three-day course of either ocular ointment combinations of chloramphenicol-clotrimazole or chloramphenicol-placebo (all three times daily). At day 3, 169 (100%) participants in the chloramphenicol-clotrimazole arm and 203 (99%) out of 205 participants in the chloramphenicol-placebo arm were cured without any complication, defined as complete epithelialization of the cornea without evidence of infection (RR 1.01, 95% CI 0.99 to 1.03; 374 participants; very low certainty evidence). Four participants assigned to the chloramphenicol-placebo arm experienced mild adverse events: two participants (1%) had mild chemosis and irritation, and two (1%) had small single sterile corneal infiltrates (low certainty evidence). AUTHORS' CONCLUSIONS: Given the low to very low certainty of the available evidence, any beneficial effects of antibiotic prophylaxis in preventing ocular infection or accelerating epithelial healing following a corneal abrasion remain unclear. Moreover, the current evidence is insufficient to support any antibiotic regimen being superior to another. There is a need for a well-designed RCT assessing the efficacy and safety of ocular antibiotics in the treatment of corneal abrasion with a particular focus on high-risk populations and formulation of interventions.

A Multiband Shared Aperture MIMO Antenna for Millimeter-Wave and Sub-6GHz 5G Applications.

A shared aperture 2-element multiple-input-multiple-output (MIMO) antenna design for 5G standards is presented in this study, one which uses the same radiating structure to cover both the sub-6GHz and millimeter-wave (millimeter-wave) bands. The proposed antenna comprises four concentric pentagonal slots that are uniformly separated from one another. For the sub-6GHz band, the antenna is excited by a single open-end microstrip transmission-line, while a 1 × 8 power divider (PD) connected via a T-junction structure excites the millimeter-wave band. Both the sub-6GHz and mm-wave antennas operate in a MIMO configuration. The proposed antenna design was fabricated on a 120 × 60 mm2 substrate with an edge-to-edge distance of 49 mm. The proposed sub-6GHz antenna covers the following frequency bands: 4-4.5 GHz, 3.1-3.8 GHz, 2.48-2.9 GHz, 1.82-2.14 GHz, and 1.4-1.58 GHz, while the millimeter-wave antenna operates at 28 GHz with at least 500 MHz of bandwidth. A complete antenna analysis is provided via a step-by-step design procedure, an equivalent circuit diagram showing the operation of the shared aperture antenna, and current density analysis at both millimeter-wave and sub-6GHz bands. The proposed antenna design is also characterized in terms of MIMO performance metrics with a good MIMO operation with maximum envelop correlation coefficient value of 0.113. The maximum measured gain and efficiency values obtained were 91% and 8.5 dBi over the entire band of operation. The antenna is backward compatible with 4G bands and also encompasses the sub-6GHz and 28 GHz bands for future 5G wireless communcation systems.

Clinical and Epidemiological Characteristics of COVID-19 Patients with SARS-CoV-2 Re-Detected on PCR Test after Discharge from Isolation.

There have been multiple reports of patients with coronavirus disease (COVID-19) testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after discharge; however, information on the characteristics of such cases is limited. In this case report, we aimed to identify clinical and epidemiological characteristics of patients who had a repeat positive polymerase chain reaction (PCR) test for SARS-CoV-2. We analyzed data of 22 COVID-19 patients who tested positive for SARS-CoV-2 on polymerase chain reaction (PCR) testing after two consecutive negative PCR results following discharge from hospitals. The interval between the two positive tests in the episodes of COVID-19 ranged from 4 to 117 days. More than one-third of the cases were healthcare workers (HCWs) and one-third of them had comorbidities. The main symptoms were cough and fever, and we noticed that males experienced more symptoms and signs of COVID-19 than females. Individuals with repeat SARS-CoV-2 positivity tend to experience milder illness during the second episode than the first episode. To confirm the reinfection of SARS-CoV-2, the results of other tests, such as viral culture and immunological assays of immunoglobulin G (IgG) and immunoglobulin M (IgM), need to be considered. Recovered COVID-19 patients should continue social distancing, using face masks, and practicing hand hygiene, especially HCWs who are more likely to be exposed to SARS-CoV-2.