The unique risk factor profile of triple negative breast cancer: a comprehensive meta-analysis.

BACKGROUND: Triple-negative breast cancer (TNBC) has a poor prognosis compared to other breast cancer subtypes. This systematic review and meta-analysis examines whether known risk factors for breast cancer are also associated with TNBC in adult females. METHODS: EMBASE, Medline, SCOPUS, and grey literature were queried with no limit on the date or language of publication. The exposures of interest included parity, breastfeeding, duration of breastfeeding, age at menarche, age at first live birth, oral contraceptive (OC) use, duration of OC use, use of menopausal hormone therapy (MHT), family history, body mass index (BMI), alcohol use, smoking and breast density. The main outcome of interest was TNBC. Study quality was determined using the Newcastle-Ottawa scale for case control studies and cohort studies. We estimated weighted odds ratios from random effects models to study the exposure-outcome associations. Protocol was registered under the number: PROSPERO 2021 CRD42021254594. RESULTS: Thirty-three studies were included. Family history, longer duration of oral contraceptive use, and higher breast density were significantly associated with increased risk for TNBC, whereas, later age at menarche, later age at first birth and breastfeeding were protective against TNBC. Parity, MHT, alcohol, smoking, and BMI were not significantly associated with TNBC overall, but higher parity was associated with higher risk among Black women. CONCLUSION: Our findings highlight that TNBC has a distinct risk-factor profile compared to overall breast cancer. This can be the foundational work in identification of actionable TNBC risk factors to improve prevention and early detection of these poor prognosis breast tumors.

Improved cookstoves to reduce household air pollution exposure in sub-Saharan Africa: A scoping review of intervention studies.

Household air pollution (HAP), primarily from biomass fuels used for cooking, is associated with adverse health outcomes and premature mortality. It affects almost half of the world's population, especially in low-income and low-resourced communities. However, many of the 'improved' biomass cookstoves (ICS) aimed at reducing HAP lack empirical evidence of pollutant reduction and reliability in the field. A scoping review guided by the Joanna Briggs Institute framework was systematically conducted to explore and analyse the characteristics of cookstoves to assess the ICS available to meet the socio-economic and health needs of households in sub-Sahara Africa (sSA). The review searched Scopus, PubMed, Web of Science, EMBASE, Global Health Database on OVID, BASE, and conducted a grey literature search from 2014 to 2022 for all field-based ICS studies. In addition, user perspectives were explored for cookstoves analysed as available, affordable, and effective in reducing harmful biomass emissions. The search returned 1984 records. Thirty-three references containing 23 ICS brands were included. The cookstoves were analysed into seven categories: (1) efficiency in HAP reduction, (2) availability, (3) affordability, (4) sustainability, (5) safety, (6) health outcomes, and (7) user experience. Most (86.9%) of the improved cookstoves showed a reduction in harmful emission levels compared to the traditional three-stone fire. However, the levels were higher than the WHO-recommended safe levels. Only nine were priced below 40 USD. Users placed emphasis on cookstoves' suitability for cooking, fuel and time savings, safety, and price. Equality in cooking-related gender roles and psychosocial benefits were also reported. The review demonstrated limited field testing, a lack of evidence of ICS emissions in real-life settings in sSA, heterogeneity in emission measurements, and incomplete descriptions of ICS and kitchen features. Gender differences in exposure and psychosocial benefits were also reported. The review recommends improved cookstove promotion alongside additional measures to reduce HAP at a cost affordable to low-resource households. Future research should focus on detailed reporting of study parameters to facilitate effective comparison of ICS performance in different social settings with different local foods and fuel types. Finally, a more community-based approach is needed to assess and ensure user voices are represented in HAP intervention studies, including designing the cookstoves.

Surgeon-Performed Point-of-Care Ultrasound in the Diagnosis of Acute Sigmoid Diverticulitis: A Pragmatic Prospective Multicenter Cohort Study.

Background and purpose Early diagnosis and risk stratification of sigmoid diverticulitis rely heavily on timely imaging. Computerized tomography (CT), the gold standard diagnostic test, may be delayed due to resource constraints or patient comorbidity. Point-of-care ultrasound (POCUS) has an established role in trauma evaluation, and could potentially diagnose and stage acute diverticulitis, thus shortening the time to definitive treatment.  Aims This study aimed to benchmark the accuracy of surgeon-performed POCUS against CT in diagnosing and staging acute diverticulitis. A secondary aim was to evaluate the duration between the POCUS and the confirmatory CT scan report. Patients and methods A pragmatic prospective multicenter cohort study (ClinicalTrials.gov Identifier: NCT02682368) was conducted. Surgeons performed point-of-care ultrasound as first-line imaging for suspected acute diverticulitis. POCUS diagnosis and radiologic Hinchey classification were compared to CT as the reference standard. Results Of 45 patients with suspected acute diverticulitis, POCUS classified 37 (82.2%) as uncomplicated diverticulitis, four (8.8%) as complicated diverticulitis, and four (8.8%) as other diagnoses. The POCUS-estimated modified radiologic Hinchey classification was largely concordant with CT staging with an accuracy of 88.8% (95% CI, 75.95-96.2%), a sensitivity of 100% (95% CI, 90.2- 100%) and a specificity of 44.4% (95% CI, 13.7-78.8%). The positive predictive value (PPV) was 87.8% and the negative predictive value (NPV) was 100%. There was moderate agreement between CT and POCUS, with a Cohen's kappa coefficient of 0.56. The mean delay between CT and POCUS was 9.14 hours (range 0.33 to 43.5). Conclusion We examined the role of POCUS in the management of acute diverticulitis and our findings suggest that it is a promising imaging modality with the potential to reduce radiation exposure and treatment delays. Adding a POCUS training module to the surgical curriculum could enhance diagnosis and expedite the management of acute diverticulitis.

Safety and efficacy of COVID-19 prime-boost vaccinations: Homologous BBIBP-CorV versus heterologous BNT162b2 boosters in BBIBP-CorV-primed individuals.

BACKGROUND: Booster vaccine doses against SARS-CoV-2 have been advocated to address evidence of waning immunity, breakthrough infection, and the emergence of immune-evasive variants. A heterologous prime-boost vaccine strategy may offer advantages over a homologous approach, but the safety and efficacy of this approach with the mRNA vaccine BNT162b2 (BNT: Pfizer) and inactivated BBIBP-CorV (BBIBT: Sinopharm) vaccines have not been studied. METHODS: We conducted a non-randomized, non-blinded phase II observational community trial acrossBahrain, investigating the reactogenic and immunogenic responseof participants who had previously received two doses of BBIBP, followed by a third booster dose of either BBIBP (homologous booster) or BNT (heterologous booster). Immunogenicity through serological statuswas determined at baseline and on the following 8thweek. Reactogenicity data (safety and adverse events) were collected throughout study period, in addition to participant-led electronic journaling. RESULTS: 305 participants (152 BBIBP and 153 BNT booster) were enrolled in the study,with 246 (127 BBIBP and 119 BNT booster) included in the final analysis. There was a significant increase in anti-SARS-CoV-2 antibody levels post booster administration in both groups; however, the heterologous BNT arm demonstrated a significantly larger mean increase in the level of spike (S) antigen-specific antibodies (32.7-fold increase versus 2.6, p < 0.0001) and sVNT neutralising antibodies (3.4-fold increase versus 1.8, p < 0.0001), whereas the homologous arm demonstrated a significant increase in the levels of nucleocapsid (N) antigen-specific antibodies (3.8-fold increase versus none). Non-serious adverse events (injection site pain, fever, and fatigue) were more commonly reported in the heterologous arm, but no serious adverse events occurred. CONCLUSION: Heterologous prime-boost vaccination with the mRNA BNT162b2 (Pfizer) vaccine in those who had received two doses of inactivated virus BBIBP-CorV (Sinopharm) vaccine demonstrated a more robust immune response against SARS-CoV-2 than the homologous BBIBP booster and appears safe and well tolerated. Clinical Trial Registry Number (ClinicalTrials.gov): NCT04993560.

The Impact of COVID-19 on the Prevalence and Perception of Telehealth Use in the Middle East and North Africa Region: Survey Study.

BACKGROUND: Due to the COVID-19 pandemic, telehealth has become a safer way to access health care. The telehealth industry has rapidly expanded over the last decade as a modality to provide patient-centered care. However, the prevalence of its use and patient acceptability remains unclear in the Middle East and North Africa (MENA) region. OBJECTIVE: The primary aim was to assess the prevalence of telehealth use before and during the pandemic by using social media (Instagram) as an online platform for survey administration across different countries simultaneously. Our secondary aim was to assess the perceptions regarding telehealth among those using it. METHODS: An Instagram account that reaches 130,000 subjects daily was used to administer a questionnaire that assessed the current prevalence of telehealth use and public attitudes and acceptability toward this modality of health care delivery during the COVID-19 pandemic. RESULTS: A total of 1524 respondents participated in the survey (n=1356, 89% female; median age 31 years), of whom 97.6% (n=1487) lived in the Gulf Cooperation Council (GCC) region. Prior to COVID-19, 1350 (88.6%) had no exposure to telehealth. Following the COVID-19 pandemic, telehealth use increased by 251% to a total of 611 users (40% of all users). About 89% (571/640) of telehealth users used virtual visits for specialist visits. Of the 642 participants who reported using telehealth, 236 (36.8%) reported their willingness to continue using telehealth, 241 (37.5%) were unsure, and 164 (25.5%) did not wish to continue to use telehealth after the COVID-19 pandemic. An inverse trend, although not statistically significant, was seen between willingness to continue telehealth use and the number of medical comorbidities (odds ratio [OR] 0.81, 95% CI 0.64-1.03; P=.09). Compared to the respondents who chose only messaging as the modality they used for telehealth, respondents who chose both messaging and phone calls were significantly less likely to recommend telehealth (OR 0.42, 95% CI 0.22-0.80; P=.009). Overall, there was general satisfaction with telehealth, and respondents reported that telehealth consultations made them feel safer and saved both time and money. CONCLUSIONS: Telehealth use increased dramatically after the COVID-19 pandemic, and telehealth was found to be acceptable among some young adult groups on Instagram. However, further innovation is warranted to increase acceptability and willingness to continue telehealth use for the delivery of health care.

Exploring changes in levels and patterns of physical activity in undergraduate medical and nursing students during the COVID-19 pandemic.

This study reports the physical activity (PA) levels among medical and nursing students at a university in Bahrain during the COVID-19 pandemic. Through self-selection sampling of an online survey, participants' data on general demographics, PA levels before and during the COVID-19 pandemic and reasons for PA changes were collected. From the 110 valid responses, 70 participants (63%) experienced a decrease in PA during the COVID-19 lockdown. Fear of contracting COVID-19 and lack of motivation were two significant reasons for reduced PA levels (p < 0.001) compared to those who did not experience a decrease in PA. Other factors significantly associated with reduced PA levels include living alone (p < 0.018) or with roommates (p < 0.006) compared to living with family. Having more time available was associated with positive changes to PA levels (p < 0.001). Significant differences in MET-min/week were seen between students who experienced increased PA (median of 1605 MET-min/week) compared to those who experienced a decrease (424 MET-min/week) or no change (1070 MET-min/week) in PA levels (p < 0.001). In conclusion, low PA levels are prevalent within medical and nursing students in Bahrain (51% reported < 600 MET-min/week), with ~2 in 3 students reporting a decrease in PA levels during the COVID-19 pandemic. Support programs and strategies to increase engagement in PA within this population are warranted.

A case-control study of polychlorinated biphenyl association with metabolic and hormonal outcomes in polycystic ovary syndrome.

Polychlorinated biphenyls (PCBs) are a class of environmental pollutants with a long half-life that sequester in fat. Women with polycystic ovarian syndrome (PCOS) may represent a sensitive subgroup to endogenous exposure to PCBs because of associated weight gain. Seven PCB congeners were compared in age, ethnicity, and BMI matched women with (n = 29) and without (n = 30) PCOS and related to metabolic outcomes, and steroid and thyroid hormone levels. PCB118, PCB138, PCB153, and PCB180 were detected in all serum samples but geometric mean did not differ between cases and controls. PCBs correlated with increasing concentrations of each other (p < .01), increasing age (p < .01) and decreasing lneGFR (p < .05). lnPCB118 correlated with increasing Free-T4 (p = .028). lnPCB158, lnPCB180, and ln∑PCB correlated with increasing lnSHBG (p = .044). In regression modeling, although not significant, PCB118 positively associated with lnSHBG in controls (p = .0504) but not in cases; estradiol inversely associated with PCB138 in controls (p = .055) and ∑PCB in cases (p = .051). No significant associations were observed between metabolic endpoints, and steroid and thyroid hormone levels. The results presented do not suggest the PCOS cases in this cohort are at adverse risk compared to age, ethnicity, and BMI matched controls.

Slow and Steady Wins the Race: 25 Years Developing the GLP-1 Receptor as an Effective Target for Weight Loss.

Recent evidence from clinical trials supports the efficacy and tolerability of glucagon-like peptide 1 (GLP-1) receptor agonists as useful agents for weight loss. Although originally developed as glucose lowering agents for people with type 2 diabetes, progress in research over the last 3 decades has demonstrated that GLP-1 receptor agonists act in the central nervous system to reduce food intake. This minireview summarizes key aspects of GLP-1 biology and the clinical studies supporting the utility of the GLP-1 receptor signaling system as a therapeutic target for weight loss.

Randomized controlled trial of favipiravir, hydroxychloroquine, and standard care in patients with mild/moderate COVID-19 disease.

Favipiravir has antiviral activity against influenza, West Nile virus, and yellow fever virus and against flaviviruses. The objective of this pilot study was to compare three arms: favipiravir; hydroxychloroquine; standard care (no specific SARS-CoV-2 treatment) only, in symptomatic patients infected by SARS-CoV-2 in an open-labelled randomized clinical trial. The trial was registered with Bahrain National Taskforce for Combatting COVID-19 on the 7th of May 2020 (registration code: NCT04387760). 150 symptomatic patients with COVID-19 disease were randomized into one of three arms: favipiravir, hydroxychloroquine, or standard care only. The primary outcome was the clinical scale at the end of study follow up (day 14 or on discharge/death) based on a points scale. The secondary outcomes were viral clearance, biochemical parameter changes and mortality at 30-days. Baseline characteristics did not differ between groups. The proportion of patients who achieved a clinical scale < 2 did not differ between groups. The favipiravir-treated and hydroxychloroquine-treated group showed increased viral clearance (OR, 95%CI 2.38, 0.83-6.78, OR, 95%CI 2.15, 0.78-5.92, respectively) compared to standard care, but this was not significant. The biochemical profile did not differ between groups, except for the platelet count (P < 0.03) and uric acid (P < 0.004) that were higher with favipiravir-treatment. Primary or secondary outcome measures did not differ between favipiravir, hydroxychloroquine, and standard therapy for mild to moderate COVID-19 disease; therefore, whilst favipiravir therapy appeared safe with a trend to increased viral clearance, there was no superior therapeutic utility.Clinical trials registration. NCT04387760. Registration date: 07/05/2020.

COVID-19 Recovery Patterns Across Alpha (B.1.1.7) and Delta (B.1.617.2) Variants of SARS-CoV-2.

Background: B.1.1.7 (alpha) and B.1.617.2 (delta) variants of concern for SARS-CoV-2 have been reported to have differential infectivity and pathogenicity. Difference in recovery patterns across these variants and the interaction with vaccination status has not been reported in population-based studies. Objective: The objective of this research was to study the length of stay and temporal trends in RT-PCR cycle times (Ct) across alpha and delta variants of SARS-CoV-2 between vaccinated and unvaccinated individuals. Methods: Participants consisted of patients admitted to national COVID-19 treatment facilities if they had a positive RT-PCR test for SARS-CoV-2, and analysis of variants was performed (using whole genome sequencing). Information on vaccination status, age, sex, cycle times (Ct) for four consecutive RT-PCR tests conducted during hospital stay, and total length of hospital stay for each participant were ascertained from electronic medical records. Results: Patients infected with the delta variant were younger (mean age = 35years vs 39 years for alpha, p<0.001) and had lesser vaccination coverage (54% vs 72% for alpha, p<0.001). RT-PCR Ct values were similar for both variants at the baseline test; however by the fourth test, delta variant patients had significantly lower Ct values (27 vs 29, p=0.05). Length of hospital stay was higher in delta variant patients in vaccinated (3 days vs 2.9 days for alpha variant) as well as in unvaccinated patients (5.2 days vs 4.4 days for alpha variant, p<0.001). Hazards of hospital discharge after adjusting for vaccination status, age, and sex was higher for alpha variant infections (HR=1.2, 95% CI: 1.01-1.41, p=0.029). Conclusion: Patients infected with the delta variant of SARS-CoV-2 were found to have a slower recovery as indicated by longer length of stay and higher shedding of the virus compared to alpha variant infections, and this trend was consistent in both vaccinated and unvaccinated patients.

Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review.

Evidence suggests that low carbohydrate (<130 g/day of carbohydrate) (LCD) and very low carbohydrate, ketogenic diets (typically <50 g/day of carbohydrate) (VLCKD) can be effective tools for managing diabetes given their beneficial effects on weight loss and glycemic control. VLCKD also result in favorable lipid profile changes. However, these beneficial effects can be limited by poor dietary adherence. Cultural, religious, and economic barriers pose unique challenges to achieving nutritional compliance with LCD and VLCKD. We review the various methods for assessing adherence in clinical studies and obstacles posed, as well as potential solutions to these challenges.

Which Biomass Stove(s) Capable of Reducing Household Air Pollution Are Available to the Poorest Communities Globally?

Globally, household and ambient air pollution (HAAP) leads to approximately seven million premature deaths per year. One of the main sources of household air pollution (HAP) is the traditional stove. So-called improved cookstoves (ICS) do not reduce emissions to levels that benefit health, but the poorest communities are unlikely to have access to cleaner cooking in the medium term. Therefore, ICS are being promoted as an intermediate step. This paper summarises the current evidence on the ICS available to the global poorest, utilising data from the Clean Cookstoves Catalog and systematic review evidence from the field. The cheapest stoves offer little reduction in HAP. Only one ICS, available at US$5 or less, (the canarumwe) minimally reduced pollutants based on ISO testing standards and no studies included in the systematic reviews reported tested this stove in the field. We recommend field testing all ICS as standard, and clear information on stove characteristics, sustainability, safety, emissions efficiency, in-field performance, affordability, availability in different settings, and the ability of the stove to meet community cooking needs. In addition, ICS should be promoted alongside a suite of measures, including improved ventilation and facilities to dry wood, to further reduce the pollutant levels.

Is glucose-6-phosphatase dehydrogenase deficiency associated with severe outcomes in hospitalized COVID-19 patients?

Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is known to suppress the antioxidant system and is likely to aggravate severity of COVID-19, which results in a pro-oxidant response. This possible association has not been explored adequately in human studies. In this research, we report that the occurrence of non-invasive ventilation, intubation or death-all of which are indicative of severe COVID-19, are not significantly different in hospitalized COVID-19 patients with and without G6PDd (4.6 vs. 6.4%, p = 0.33). The likelihood of developing any of these severe outcomes were slightly lower in patients with G6PDd after accounting for age, nationality, presence of comorbidities and drug interventions (Odds ratio 0.40, 95% confidence intervals 0.142, 1.148). Further investigation that extends to both, hospitalized and non-hospitalized COVID-19 patients, is warranted to study this potential association.

Do improved biomass cookstove interventions improve indoor air quality and blood pressure? A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis evaluates the most recent evidence to examine whether use of improved biomass cookstoves in households in low-middle income countries results in reduction in mean concentrations of carbon monoxide (CO) and particulate matter of size 2.5 µm (PM2.5) in the cooking area, as well as reduction in mean systolic (SBP) and diastolic blood pressure (DBP) of adults using the cookstoves when compared to adults who use traditional three stone fire or traditional biomass cookstoves. METHODS: We searched databases of scientific and grey literature. We included studies if published between January 2012 and June 2021, reported impact of ICS interventions in non-pregnant adults in low/middle-income countries, and reported post-intervention results along with baseline of traditional cookstoves. Outcomes included 24- or 48-h averages of kitchen area PM2.5, CO, mean SBP and DBP. Meta-analyses estimated weighted mean differences between baseline and post-intervention values for all outcome measures. RESULTS: Eleven studies were included; ten contributed estimates for HAP and four for BP. Interventions lead to significant reductions in PM2.5 (-0.73 mg/m3, 95% CI: -1.33, -0.13), CO (-8.37 ppm, 95%CI: -13.20, -3.54) and SBP (-2.82 mmHg, 95% CI: -5.53, -0.11); and a non-significant reduction in DBP (-0.80 mmHg, 95%CI: -2.33, 0.73), when compared to baseline of traditional cookstoves. Except for DBP, greatest reductions in all outcomes came from standard combustion ICS with a chimney, compared to ICS without a chimney and advanced combustion ICS. CONCLUSION: Among the reviewed biomass stove types, ICS with a chimney feature resulted in greatest reductions in HAP and BP.

Epidemiology of pediatric trauma in the Kingdom of Bahrain: a national pediatric trauma registry pilot study.

BACKGROUND: A pediatric trauma registry for the Kingdom of Bahrain would be a novel public health tool for the Bahraini health system. The aim of this study was to explore the epidemiology of pediatric trauma at the national level by describing the distribution of pediatric injury in the Kingdom, and quantifying the burden of injury shouldered by the study population. METHODS: This multicenter observational cross-sectional study was conducted in Bahrain using data from the Pediatric Trauma Registry (PTR), which was a short-term paper-based prospective trauma registry that collected data over a three-month period in 2018. PTR was based in the pediatric emergency departments (ED) of the three national referral hospitals in the Kingdom. By simultaneously collecting data from all three trauma hospitals in the country, it was assumed that during the data collection period all major pediatric trauma patients in the country would be captured by the study, and that the data collected would provide national estimates of trauma. Inclusion criteria for the study was any individual under the age of 14, that arrived at the ED seeking care for intentional and unintentional injuries. RESULTS: A total of 1328 patients were included in the study. Sixty-nine percent of patients were treated and discharged from the ED, 30.5% were admitted to the hospital, admitted for surgery, or seen by a specialist, and 0.5% were declared deceased. The percentage of patients documented as unrestrained during Motor Vehicle Collisions (MVC) was 92.3%, and amongst those involved in MVC, 12% were ejected from the cabin of the vehicle. CONCLUSIONS: There are significant implications that this study holds for policy implementation and practice surrounding injury prevention in the Kingdom of Bahrain. Low seatbelt utilization and the high proportion of ejection amongst MVC victims warrant immediate public health policy implementation, including enforcement of seat belt laws, strengthening of the traffic court system, and awareness campaigns for MVC prevention. Additionally, pediatric drowning prevention programs centered on constant adult supervision, pool isolation fencing, personal flotation devices, and swimming education should be created to address the mortality attributable to drowning in this study.

Amyloid-related protein changes associated with dementia differ according to severity of hypoglycemia.

INTRODUCTION: Hypoglycemia in type 2 diabetes (T2D) may increase risk for Alzheimer's disease (AD), but no data on changes in AD-related proteins with differing degrees of hypoglycemia exist. We hypothesized that milder prolonged hypoglycemia would cause greater AD-related protein changes versus severe transient hypoglycemia. RESEARCH DESIGN AND METHODS: Two prospective case-control induced hypoglycemia studies were compared: study 1, hypoglycemic clamp to 2.8 mmol/L (50 mg/dL) for 1 hour in 17 subjects (T2D (n=10), controls (n=7)); study 2, hypoglycemic clamp to 2.0 mmol/L (36 mg/dL) undertaken transiently and reversed in 46 subjects (T2D (n=23), controls (n=23)). Blood sampling at baseline, hypoglycemia and 24-hour post-hypoglycemia, with proteomic analysis of amyloid-related proteins performed. RESULTS: In control subjects, the percentage change from baseline to hypoglycemia differed between study 1 and study 2 for 5 of 11 proteins in the AD-related panel: serum amyloid A1 (SAA1) (p=0.009), pappalysin (PAPPA) (p=0.002), apolipoprotein E2 (p=0.02), apolipoprotein E3 (p=0.03) and apolipoprotein E4 (p=0.02). In controls, the percentage change from baseline to 24 hours differed between studies for two proteins: SAA1 (p=0.003) and PAPPA (p=0.004); however, after Bonferroni correction only SAA1 and PAPPA remain significant. In T2D, there were no differential protein changes between the studies. CONCLUSIONS: The differential changes in AD-related proteins were seen only in control subjects in response to iatrogenic induction of hypoglycemic insults of differing length and severity and may reflect a protective response that was absent in subjects with T2D. Milder prolonged hypoglycemia caused greater AD-related protein changes than severe acute hypoglycemia in control subjects. TRIAL REGISTRATION NUMBERS: NCT02205996, NCT03102801.

Time Till Viral Clearance of Severe Acute Respiratory Syndrome Coronavirus 2 Is Similar for Asymptomatic and Non-critically Symptomatic Individuals.

Despite the modeled estimations of the burden of asymptomatic spread, the duration of viral positivity and infectiousness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains understudied. The objective of the present study was to estimate and compare the time till viral clearance of SARS-CoV-2 in asymptomatic and non-critical symptomatic individuals. We studied 184 SARS-CoV-2-positive participants, of whom 145 were asymptomatic. Our analysis uncovered that time till viral negativity is similar for subclinical [median time till viral clearance: 11 days, interquartile range (IQR): 8, 14] and overt infections (median: 11 days, IQR: 9, 14) after controlling for age and sex. This has implications in understanding the period of infectivity for SARS-CoV-2 in order to plan adequate public health measures to control the community spread.

Is sickle cell disease a risk factor for severe COVID-19 outcomes in hospitalized patients? A multicenter national retrospective cohort study.

Introduction: Studies that examine the association between sickle cell disease (SCD) and COVID-19 outcomes are lacking. This study aims to determine whether SCD is a risk factor for severe COVID-19 infection in regard to the requirement of noninvasive ventilation/high flow nasal cannula (NIV/HFNC), mechanical ventilation (MV), or death in hospitalized patients. Methods: Retrospective cohort study included COVID-19 patients admitted to four COVID-19 treatment facilities in Bahrain between February 24, 2020 and July 31, 2020. All SCD patients with COVID-19 were included and compared to a randomly selected sample of non-SCD patients with COVID-19. Data were collected from the medical records. Multivariate logistic regression models were used to control for confounders and estimate the effect of SCD on the outcomes. Results: 1792 patients with COVID-19 were included; 38 of whom were diagnosed with SCD as well. In the SCD group, one (2.6%) patient required NIV/HFNC, one (2.6%) required MV, and one (2.6%) death occurred. In comparison, 56 (3.2%) of the non-SCD patients required NIV/HFNC, 47 (2.7%) required MV, and death occurred in 58 (3.3%) patients. Upon adjusting for confounders, SCD had an odds ratio of 1.847 (95% CI: 0.39-8.83; p = 0.442). Conclusion: Our results indicate that SCD is not a risk factor for worse COVID-19 outcomes in hospitalized patients.

Prevalence and Resistance Patterns of Pediatric Urinary Tract Infections in Bahrain.

Background Urinary tract infections (UTI) are a commonly encountered infection in the pediatric age group. Knowledge of the causative pathogens and their antimicrobial resistance patterns in specific geographical locations is important to provide optimum care. The aim of this study is to describe the prevalence and the antimicrobial resistance patterns of the pathogens causing UTI in the pediatric age group in one tertiary inpatient Pediatric unit in Bahrain. Methods This is a retrospective cross-sectional study, conducted at King Hamad University Hospital (KHUH), Bahrain. The inclusion criteria consisted of patients ≤ 14 years of age admitted to the Pediatrics department at KHUH with bacteriologically proven UTI between the months of January 2018 and May 2021. Patients who were identified to have chronic urinary tract conditions or neurodevelopmental problems involving the urinary tract were excluded from the study. Electronic medical records were used to collect data regarding the isolated pathogens and sensitivity testing results. Results A total of 242 cases with positive culture were included. The most common bacteria causing UTI in this sample were successively Escherichia coli (68.60%), Klebsiella pneumoniae (10.30%), Proteus mirabilis (4.69%) and Pseudomonas aeruginosa (3.31%) (p<0.01). E. coli was most resistant to cefazolin (94%), followed by ampicillin (62.68%), whilst it was most sensitive to nitrofurantoin (98.96%) followed by amikacin (98.43%) (p<0.01). K. pneumoniae showed the highest rate of resistance to ampicillin (95.24%) followed by cefazolin (83.33%), meanwhile having the highest sensitivity rate to amikacin (95.24%), followed by ciprofloxacin (90.48%). P. mirabilis had the highest resistance to cefazolin (100%) followed by nitrofurantoin (87.50%), while having the highest sensitivity to piperacillin/tazobactam (100%). Conclusion E. coli is the most common cause of UTI in the pediatric population and it was found to be most sensitive to nitrofurantoin and amikacin whilst being relatively resistant to cefazolin and ampicillin. Similarities between our study and previous studies around the world were found when comparing the antibiotics resistance patterns. Nevertheless, it is our recommendation that empirical antibiotic selection should be tailored to the local data collected from the region.