The impact of non-pharmacologic interventions on respiratory syncytial virus hospitalization during the COVID-19 pandemic: A retrospective study from Saudi Arabia.

BACKGROUND: Acute respiratory tract infections (ARTIs) are frequently observed in infants and young children. The dynamics and transmission of ARTIs have been significantly impacted by the global COVID-19 pandemic. This study investigates the change in admission rates of Respiratory Syncytial virus (RSV) in a hospital in Saudi Arabia. METHODS: The study included hospitalized pediatric patients who underwent RSV testing in three periods: pre-pandemic (2019), during the pandemic (2020-2021), and the immediate post-pandemic (2022). RSV testing was conducted using either PCR or antigen tests. RESULTS: Between January 2019 to December 2022, out of 927 tested patients, 173 (18.7%) were positive for RSV. The yearly positivity rates were as follows: 42 (35.6%) of 118, 24 (33.3%) of 72, 15 (18.5%) of 81, and 92 (14%) of 656, yearly from 2019 to 2022, respectively (P < 0.00001). Among all cases, 150 (16.2%) required hospitalization, including 94 (62.7%) males and 56 (37.3%) females. The admission rate to the intensive care unit (ICU) was 25 (16.7%), and mechanical ventilation was required for 10 (6.6%) patients. The overall case fatality rate was 0.7%. A Binary logistic regression analysis showed upper respiratory tract symptoms were more common in patients admitted in 2019 compared to 2022 (odd ratio:20.9, 95% CI: 4.2-104.1, P value < 0.0001). CONCLUSION: The study showed that there were differences in RSV infection before and after COVID-19. Understanding how COVID-19 mitigation measures affect RSV transmission can aid in the development of effective prevention and control strategies.

Clostridium difficile Infection: Risk and Poor Prognostic Factors at a Tertiary Hospital in the Eastern Region of Saudi Arabia.

BACKGROUND:  Clostridium difficile (C. difficile) is a common cause of hospital-acquired diarrhea. It is associated with significantly higher mortality and morbidity in addition to the cost-effectiveness burden on the healthcare system. The primary risk factors for C. difficile infection (CDI) are past C. difficile exposure, proton pump inhibitors, and antibiotic usage. These risk factors are also associated with poor prognosis. OBJECTIVE: This study was performed in Dr. Sulaiman Al Habib Tertiary Hospital in the Eastern Region of Saudi Arabia. The aim was to evaluate the risk and prognostic factors of CDI and their association with the outcomes of hospital stay, such as complications, length of stay (LOS), and treatment duration. PATIENTS AND METHODS: This is a retrospective cohort study for all patients who tested for C. difficile in the medical department. The target population was all adult patients ≥16 years with positive stool toxins for C. difficile between April 2019 and July 2022. The main outcome measures are risk and poor prognostic factors for CDI. RESULTS: C. difficle infection patients were included in the study; 12 (52.2%) were female, and 11 (47.8%) were male. The mean age of the patients was 58.3 (SD: 21.5) years; 13 (56.5%) patients were below 65 years, and 10 were above 65 years. Only four patients were without comorbidities, and 19 (82.6%) patients had various comorbidities. Importantly, hypertension was the most common comorbidity in 47.8% of the patients. Furthermore, advanced age significantly impacted the hospital LOS as the mean age among patients who stayed at the hospital less than four days and those who stayed ≥4 days was 49.08 (19.7) and 68.36 (19.5), respectively (P = .028). CONCLUSION:  Advanced age was the most frequent poor prognostic factor among our inpatient participants with positive CDI. It was significantly associated with longer hospital LOS, more complications, and longer treatment duration.

Methylprednisolone-Induced Symptomatic Sinus Bradycardia in a Multiple Sclerosis Patient: A Case Report.

Intermittent high-dose methylprednisolone therapy is widely used for various autoimmune conditions treatment. Common side effects are well known and monitored carefully during therapy. Although cardiovascular adverse events are uncommon, they have been increasingly reported in the literature. This is a case of a 30-year-old female who developed symptomatic sinus bradycardia after receiving three grams of intravenous methylprednisolone pulse therapy for multiple sclerosis flare-ups. Her pulse rate reached 40bpm, together with lightheadedness and chest tightness. An electrocardiogram confirmed sinus bradycardia, for which she was initially managed by splitting the methylprednisolone dose in half; however, 12 hours later, the heart rate decreased further to 35bpm, and her symptoms worsened. Subsequently, the medicine was omitted, and the patient shifted to the intensive care unit for close observation and monitoring. She was treated conservatively with close observation resulted in a gradual normalization of the heart rate. The diagnosis of methylprednisolone pulse-induced bradycardia was made after excluding other common etiologies of sinus bradycardia. This case report aims for careful cardiovascular monitoring in patients receiving high doses of methylprednisolone due to the dose-dependent cardiovascular risks.

Intracardiac Thrombus Formation and Bilateral Pulmonary Embolisms in a Patient With Behcet's Disease While on Regular Infliximab Infusion: A Case Report.

Vascular complications of Behcet'sdisease, including intracardiac thrombus formation, are one of the significant causes of mortality and morbidity in this population. Similar to other vasculitic disorders, Behcet's disease is primarily treated with immunosuppressants. While the benefit of adding anticoagulants in Behcet's disease with thromboembolism remains debatable, some literature encourages its use with concomitant intracardiac thrombus. Herewith, we present the case of a young male who was diagnosed with bilateral pulmonary embolism in addition to right ventricle intracardiac thrombus upon his scheduled dose of infliximab infusion. He was managed by adding azathioprine to his regimen together with oral prednisolone and warfarin with a target international normalized ratio of 2-3. This case report addresses the importance and outcome of early identification of Behcet's disease's vascular complications and immediate initiation of anticoagulation accordingly.

Laryngopyocele: report of a rare case and systematic review.

A systematic review on laryngopyoceles across Ovid, PubMed, and Google Scholar database was conducted. A total of 61 papers published between 1952 and 2015 were found. Of these, 23 cases written in English, which described the number of cases, surgical approaches, resort to tracheostomy, complications, and outcomes, were shortlisted. Four cases of laryngopyoceles were managed endoscopically using a cold instrument, microdebrider, or laser. Eighteen cases were operated via an external approach, and 1 case applied both approaches. One of 4 endoscopic and 10 of 18 external approaches involved tracheostomy. The present study aimed to report a case of large mixed laryngopyocele that was successfully drained and marsupialized endoscopically using suction diathermy without requiring tracheostomy. Management using suction diathermy for excision and marsupialization of a laryngopyocele has never been reported and can be recommended as a feasible method due to its widespread availability. In the presence of a large laryngopyocele impeding the airway, tracheostomy may be averted in a controlled setting. SIMILAR CASES PUBLISHED: None specified.

Butterflies (Lepidoptera: Nymphalidae) Associated with Pig Carrions in Malaysia / Jurnal Sains Kesihatan Malaysia

An entomological study was conducted in Tanjung Sepat, Selangor, Malaysia in May until September 2007 revealing five species of butterflies (all from family Nymphalidae) were attracted to pig carcasses placed in an oil palm plantation. Euploea mulciber (Cramer 1777), Hypolimnas bolina (Linnaeus 1758), Elymnias hypermnestra (Linnaeus 1763), Mycalesis mineus (Linnaeus 1758) and Ypthima baldus (Fabricius 1775) came to the carcasses at different stages of decomposition. From this study, we know that nymphalid butterflies are attracted to carcasses but their roles are most probably unimportant in post-mortem estimation.

Study of insect succession and rate of decomposition on a partially burned pig carcass in an oil palm plantation in Malaysia.

Insects found associated with corpse can be used as one of the indicators in estimating postmortem interval (PMI). The objective of this study was to compare the stages of decomposition and faunal succession between a partially burnt pig (Sus scrofa Linnaeus) and natural pig (as control). The burning simulated a real crime whereby the victim was burnt by murderer. Two young pigs weighed approximately 10 kg were used in this study. Both pigs died from pneumonia and immediately placed in an oil palm plantation near a pig farm in Tanjung Sepat, Selangor, Malaysia. One pig was partially burnt by 1-liter petrol while the other served as control. Both carcasses were visited twice per day for the first week and once thereafter. Adult flies and larvae on the carcasses were collected and later processed in a forensic entomology laboratory. Results showed that there was no significant difference between the rate of decomposition and sequence of faunal succession on both pig carcasses. Both carcasses were completely decomposed to remain stage after nine days. The species of flies visiting the pig carcasses consisted of blow flies (Chrysomya megacephala, Chrysomya rufifacies, Hemipyrellia ligurriens), flesh fly (Sarcophagidae.), muscid fly (Ophyra spinigera), soldier fly (Hermetia illucens), coffin fly (Phoridae) and scavenger fly (Sepsidae). The only difference noted was in the number of adult flies, whereby more flies were seen in the control carcass. Faunal succession on both pig carcasses was in the following sequence: Calliphoridae, Sarcophagidae, Muscidae, Phoridae and lastly Stratiomyidae. However, there was overlap in the appearance of members of these families. Blowflies continued to oviposit on both carcasses. Hence postmortem interval (PMI) can still be estimated from the partially burnt pig carcass.

On the occurrence of Musca domestica L oviposition activity on pig carcass in peninsular Malaysia.

A forensic entomological study conducted in an oil palm plantation in Tanjung Sepat, Selangor, Malaysia on 3 August 2007 revealed that a housefly, Musca domestica Linnaeus oviposited its eggs on a freshly dead pig. This finding indicated that housefly might play an important role in forensic investigation in determining post-mortem interval (PMI), although it was not yet found in human corpses or any animal carrion. This preliminary paper presented a first record of Musca domestica eggs found on animal carcass in the country.

A new record of Bengalia emarginata Malloch, 1927 (Diptera: Calliphoridae) from Malaysia.

During a forensic entomological study conducted at an oil palm plantation in Tanjung Sepat, Kuala Langat, Selangor, a Bengalia emarginata Malloch, 1927 (Diptera: Calliphoridae: Calliphorinae: Bengalini) was collected for the first time. Two adults were collected nearby the pig carcass by the first author and identified by the second. Prior to this finding, nine species of Bengalia were recorded from peninsular Malaysia or Borneo. Male of B. emarginata are different from Bengalia varicolor Fabricious by the following characters: Sternite 5 projection rounded with small identation and mid tibia double-fringed in ventral surface.

First report of the signal fly, Scholastes sp. (Diptera:Platystomatidae) visiting animal carcasses in Malaysia.

Signal fly, Scholastes sp. (Diptera: Platystomatidae) was observed associated with animal carcasses in Malaysia. The first observation was on a monkey carcass, which was killed by using a handgun and immediately placed in a forested area in Gombak, Selangor while the second observation was on a pig that died of natural causes and whose carcass was placed in an oil palm plantation in Tanjung Sepat, Selangor. Both animal carcasses were visited by Scholastes sp. flies during the fresh decomposition period. However, the role Scholastes flies in the decomposition process remains unknown. In this paper, we report the occurrence of Scholastes sp. on animal carcasses in Malaysia for the first time.

Flies Specimens Collected from Agricultural Park, Teluk Cempedak and Bukit Pelindung in Kuantan, Pahang / Jurnal Sains Kesihatan Malaysia

This study was carried out in Agricultural Park, Teluk Cempedak and Bukit Pelindung at Kuantan, Pahang in October 2007. These three areas were different in ecological characteristic, Agricultural Park is a lowland region in Kuantan rural area, Teluk Cempedak is Kuantan’s most famous beach, and Bukit Pelindung is a reserved rainforest which is 200 meters from the sea level. Fly specimens were collected using four different kinds of baits: dry prawn, salted fish, pork and mango. Each of these baits was placed in a plastic container and exposed for one hour to attract flies. Within 5 minutes, flies started swarming around the baits. The flies were more attracted to the pork and salted fish compared to the other two baits. Fifty one flies, one moth (Lepidoptera) and one wasp (Hymenoptera) were collected. In Agricultural Park, two Lucilia cuprina, one Chrysomya megacephala and one Sarcophaga sp. were collected. For Teluk Cempedak beach, there were two Sarcophagids, 31 Chrysomya megacephala, five Musca domestica, one Lucilia cuprina and one moth were caught. Flies collected from Bukit Pelindung included five C.megacephala, two Sarcophagids, one Musca domestica and one wasp. Most C.megacephala were attracted to the pork and salted fish.