Disseminated Melioidosis Presenting as Sepsis, Neurological Melioidosis, Liver and Prostate Abscess in United Arab Emirates.

Background: Melioidosis is an infection caused by Burkholderia pseudomallei, a Gram-negative bacterium. It is a disease endemic to Southeast Asia and northern Australia although its global incidence has been rising. It most commonly infects people with certain identified risk factors such as diabetes, alcoholism, thalassemia, and underlying chronic disease involving lungs, kidney and liver. This bacterium is capable of producing a wide array of clinical manifestations ranging from asymptomatic disease to localised infections such as in the lung, bone or skin to disseminated infection. Case description: This is a case, from United Arab Emirates, of a 40-year-old male recently diagnosed with diabetes who presented with multiple abscesses and was eventually diagnosed with disseminated melioidosis. He was treated successfully with antibiotics and drainage of abscesses. Conclusion: In non-endemic regions, melioidosis can be easily missed in common diagnostic approaches. This gap of awareness could delay the diagnosis and allow further deterioration of the patient due to complications. Thus, case reports like this can enlighten internists about changing incidences and complexity of clinical presentations, thus preparing them to better handle such patients in the future. LEARNING POINTS: Owing to its considerably rare incidence in non-endemic regions including the United Arab Emirates, melioidosis can easily be overlooked or misdiagnosed.Moreover, due to similarity with multiple other diseases and infections as well as significant absence from standard medical curricula, melioidosis is rarely on the differential list of an internist.This report aims to enhance awareness and alertness to aid earlier detection and avoid severe complications.

Incidence of Low Seroimmunity to Hepatitis B Virus in Children with Inflammatory Bowel Disease: A Single Center Experience.

Purpose: Immunosuppressive therapy is frequently administered to patients with inflammatory bowel disease (IBD), which may make them more susceptible to infections like hepatitis B. Methods: A cross-sectional study was conducted on patients aged 5-18 years diagnosed with IBD who visited a gastroenterology clinic along with controls who were the same age as the patients with IBD and were healthy overall. A logistic regression analysis using the independent variables of age, sex, race, disease phenotype, surgery, and medications and the dependent variable of adequate hepatitis B surface antibody (HBsAb) titers (>10 mIU/mL) was performed on quantitative serum HBsAb titers. Results: The study enrolled 62 patients, including 37 males and 25 females. Crohn's disease, ulcerative colitis, and indeterminate colitis were diagnosed in 16, 22, and 24 patients, respectively. Thirty-nine patients were taking corticosteroids at the time of the study, 42 were taking immunomodulators, and four were taking biologics. Compared to 44.7% of the control group, 9.3% of the patients had protective titers. Only 12 out of 62 patients had HBsAb titers greater than 10 million IU/mL. None of the patients who received biologics or corticosteroids and 3.2% of those who received immunomodulators were found to be seroimmuned. Conclusion: The younger patients had the highest titers. Patient-specific factors that may impact these low titers include the length of the patient's illness and the use of immunosuppressants.

The Effect of Ventilator-Associated Pneumonia on the Time-to-Extubation in Adult and Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study.

INTRODUCTION: Ventilator-associated pneumonia (VAP) ranks as a prominent hospital-acquired infection. VAP has been shown to have a detrimental impact on patients and healthcare facilities, leading to extended hospital stays, increased demands on medical resources, and higher financial expenses. This study aims to assess the influence of VAP on time-to-extubation and length of hospital stay (LOS) in patients requiring mechanical ventilation for more than 48 hours in pediatric and adult intensive care units (ICU). METHODS: This retrospective cohort study included adult and pediatric ICU patients admitted to King Abdul-Aziz Medical City in Jeddah, Saudi Arabia, from June 2016 to May 2020. The study encompassed ICU patients who required mechanical ventilation for more than 48 hours. Time-to-extubation and LOS were measured in days and compared between those who developed VAP and those who did not. A Kaplan-Meier curve was employed to estimate and compare both groups' survival functions (time-to-event). RESULTS: The study involved 367 subjects, with 226 adults and 141 pediatric patients. Among the 367 mechanically ventilated patients, 33 (8.99%) developed VAP during their ICU stay, with 9 of them being children. VAP patients experienced a significantly longer time to extubation than non-VAP patients (13.5 vs. six days, p<0.0001). Likewise, ICU stays for VAP patients were significantly longer than those for non-VAP patients (19.5 vs. 13 days, p<0.002). However, the mortality rate at 28 days from intubation did not exhibit significant differences between the VAP and non-VAP groups (36.36% vs. 27.54%, p=0.283). CONCLUSION: This study underscores that VAP patients face a substantial delay in time-to-extubation and an increased length of ICU stay compared to non-VAP patients. Such findings substantially impact the cost of hospital care and the risk of exposure to other infection-related complications while under mechanical ventilation. Enhanced preventive measures are warranted to reduce the occurrence and consequences of VAP.

Healthcare Professionals' Experiences During the COVID-19 Pandemic in Sudan: A Cross-Sectional Survey Assessing Quality of Life, Mental Health, and Work-Life-Balance.

Objectives: The main objective of this research was to investigate the Work-life balance (WLB), mental health, and quality of life and their associated factors among Healthcare Professionals (HCPs) in Sudan during the peak of the COVID-19 pandemic during 2021. Methods: An observational cross-sectional web-based survey was conducted during August-December 2021 among a sample of 430 HCPs working in the hospitals of four Sudanese states. The study used the WHOQoLBREF scale, Work-Life Balance Scale, and General Anxiety Disorder (GAD-7). Results: HCPs reporting a poor quality of life made up 33.5% (95% CI 29.1-38.0), while those reporting worse WLB made up 52.6% (95% CI 47.8-57.2). HCPs reporting moderate to severe anxiety symptoms accounted for 35.8% (95% CI 31.4-40.5). The Multiple Regression model indicated that an increase in the anxiety scores is associated with a decrease in Health-related Quality of Life (HRQoL) (ß= 0.831, p < 0.05). Female HCPs exhibited 4.53-fold lower HRQoL scores than their male colleagues (p < 0.05). Conclusion: Approximately one-third of the HCPs in Sudan reported low HRQoL and suffered from moderate to severe anxiety, while a large portion of them had an unequal work-life balance during COVID-19. Health policies addressing these factors are needed to improve the quality of health of HCPs.

Epidemiology and Risk Factor Analysis of Children with Bronchiolitis Admitted to the Intensive Care Unit at a Tertiary Care Center in Saudi Arabia.

Bronchiolitis is a leading cause of hospitalization worldwide for children aged ≤2 years. Few studies have compared general ward and pediatric intensive care unit (PICU) admissions, particularly in Saudi Arabia. This retrospective cohort study aimed to compare the demographic and clinical characteristics of children with bronchiolitis admitted to the general ward with those admitted to the PICU. Children (≤6 years) previously diagnosed with bronchiolitis and admitted to the PICU or general ward at a tertiary center in Saudi Arabia between May 2016 and May 2021 were included. Multiplex polymerase chain reaction was used to identify respiratory viruses. Of the 417 patients enrolled, 67 (16.06%) were admitted to the PICU. The PICU group was younger (median, 2 months; interquartile range [IQR], 1-5 months) vs. (6 months; IQR, 2.65-13.25 months). There was a dramatic reduction in bronchiolitis admissions during the COVID-19 pandemic. The most common causative virus was respiratory syncytial virus (RSV) (54.9%). In the multivariate regression analysis, hypoxia, hyperinflation on X-ray, and non-RSV bronchiolitis were independently associated with PICU admission. However, a higher chronological age and cough were protective. Children with Down syndrome, immunodeficiency, or neuromuscular disorders, and intermediate preterm infants (29-33 weeks of gestation) are at a high risk of PICU admission (adjusted odds ratio: 2.4, 7.1, 2.9, and 2.9; p = 0.037, 0.046, 0.033, and 0.029, respectively). Bronchiolitis is still one of the leading causes of PICU admission. Particular attention should be paid to preventive measures, especially in the post-COVID-19 era, targeting high-risk groups.

Selective COVID-19 Coinfections in Diabetic Patients with Concomitant Cardiovascular Comorbidities Are Associated with Increased Mortality.

Coinfections and comorbidities add additional layers of difficulties into the challenges of COVID-19 patient management strategies. However, studies examining these clinical conditions are limited. We have independently investigated the significance of associations of specific bacterial species and different comorbidities in the outcome and case fatality rates among 129 hospitalized comorbid COVID-19 patients. For the first time, to best of our knowledge, we report on the predominance of Klebsiella pneumoniae and Acinetobacter baumannii in COVID-19 non-survival diabetic patients The two species were significantly associated to COVID-19 case fatality rates (p-value = 0.02186). Coinfection rates of Klebsiella pneumoniae and Acinetobacter baumannii in non-survivors were 93% and 73%, respectively. Based on standard definitions for antimicrobial resistance, Klebsiella pneumoniae and Acinetobacter baumannii were classified as multidrug resistant and extremely drug resistant, respectively. All patients died at ICU with similar clinical characterisitics. Of the 28 major coinfections, 24 (85.7%) were in non-survivor diabetic patients, implying aggravating and worsening the course of COVID-19. The rates of other comorbidities varied: asthma (47%), hypertension (79.4%), ischemic heart disease (71%), chronic kidney disease (35%), and chronic liver disease (32%); however, the rates were higher in K. pneumoniae and were all concomitantly associated to diabetes. Other bacterial species and comorbidities did not have significant correlation to the outcomes. These findings have highly significant clinical implications in the treatment strategies of COVID-19 patients. Future vertical genomic studies would reveal more insights into the molecular and immunological mechanisms of these frequent bacterial species. Future large cohort multicenter studies would reveal more insights into the mechanisms of infection in COVID-19.