Detection of OXA-181 Carbapenemase in Shigella flexneri.

We report the detection of OXA-181 carbapenemase in an azithromycin-resistant Shigella spp. bacteria in an immunocompromised patient. The emergence of OXA-181 in Shigella spp. bacteria raises concerns about the global dissemination of carbapenem resistance in Enterobacterales and its implications for the treatment of infections caused by Shigella bacteria.

Global Asthma Network Phase I Syria asthma surveillance and the impact of the war.

Background: Asthma is the most prevalent chronic respiratory disease (CRD) in children. It causes extensive morbidity and mortality worldwide. Since the International Study of Asthma and Allergies in Childhood (ISAAC Phase III 2001-3), there have been no worldwide standardised surveys of prevalence and severity of asthma in school children. The Global Asthma Network (GAN) Phase I aims to provide this information. We participated in GAN with the aim of tracking changes in Syria and comparing the results to those of ISAAC Phase III. We also aimed to track the impact of war pollutants and stress. Methods: GAN Phase I, following the same methodology of ISAAC in a cross-sectional study. The same ISAAC questionnaire translated into Arabic was repeated. We added questions about displacement from home, and the impact of war pollutants. We also added the Depression, Anxiety and Stress Scale (DASS Score). In this article, we focused on the prevalence of 5 core asthma indicators (wheezing in the past 12 months, wheezing ever, severe wheeze, exercise wheeze and night cough) in adolescents from two centres in Syria: Damascus and Latakia. Additionally, we investigated the impact of the war on our two centres, while the DASS score was investigated only in Damascus. We surveyed 1,100 adolescents from 11 schools in Damascus and 1,215 adolescents from 10 schools in Latakia. Results: In Syria, which is a low-income country, wheeze prevalence before the war in ISAAC III was 5.2% for 13-14-year-old, whilst it was 19.28% in GAN during the war. Prevalence of severe asthma symptoms was 2.5% in ISAAC III and 12.8% in GAN. Wheezing appearing after the war or becoming more severe was statistically significant p=0.0001. War is associated with higher exposure to new environmental chemicals and pollutants and higher anxiety and depression scores. Conclusions: It is paradoxical to note that in Syria, current wheeze and severity are much higher in GAN (19.8%) than in ISAAC III (5.2%), which seems positively associated with war pollution and stress.

Raising the alarm: Mental health status of the transgender community in Pakistan.

In Pakistan, the transgender community faces many challenges. Transgender identity is considered taboo and people tend to distance themselves from them without knowing their issues. They face difficulties seeking education, jobs, and even basic human rights. They also face violence and social exploitation. Due to the lack of support from their family members, they're more prone to develop psychological problems and suicidality. Trans rights are human rights - the purpose of our paper is to expose the dire state of mental health of the transgender community in Pakistan on an international platform. We aim to bring a global concern to this problem because we hope that it will spur the relevant authorities to take steps to mitigate the current situation. Special attention should be paid to the protection and education of transgender individuals. If they're suffering from any psychiatric disorder, healthcare professionals should be there to help them.

Investigation of severe acute respiratory syndrome coronavirus 2 antibodies among the paediatric population in Mogadishu, Somalia.

BACKGROUND: We undertook this cross-sectional study to determine the level of circulating anti-severe acute respiratory syndrome coronavirus 2 immunoglobulins (IgM and IgG) in children, as well as to evaluate other potential risk factors. METHODS: Children attending the outpatient department of the SOS and Benadir Hospitals in Mogadishu from 26 July to 8 August 2021 were selected following parental consent. The children (aged <18 y) were screened using the coronavirus disease 2019 (COVID-19) rapid test lateral flow immune-assay kit. RESULTS: Of the 500 children screened for COVID-19, 32 (6.4%) tested positive, out of which 26 (5.2%) had IgG antibodies, while five (1%) had IgM, with the other child (0.2%) having both circulating IgG and IgM antibodies. Also, 46.9% of the COVID-19-positive children were asymptomatic without any clinical signs of the disease. Children aged >6 y and those attending school were the most affected (p=0.002). The most common clinical features among positive children were fever (22.6%), cough (22.2%), shortness of breath (5.8%) and loss of smell (2.6%) and taste (2.2%). Similarly, not wearing a facemask as a preventive measure was found to be a significant risk factor (p=0.007). CONCLUSIONS: This study shows that children are at risk of contracting COVID-19 infection. Our study also shows evidence of a high rate of IgG antibodies in school-aged children having close contact with infected adults, in those not wearing facemasks, as well as in those with a family history of comorbidities.

Prevalence, antimicrobial susceptibility profile, and associated risk factors of uropathogenic Escherichia coli among pregnant women attending Dr. Sumait Hospital Mogadishu, Somalia.

Background: Uropathogenic Escherichia coli (UPEC) is a strain of E. coli commonly associated with urinary tract infections. In addition, antibiotic resistance in UPEC is one of the most significant health problems. This study was conducted to determine the prevalence, antimicrobial resistance, and factors linked to uropathogenic Escherichia coli (UPEC) in pregnant women. Methods: This cross-sectional study was conducted within a hospital setting between August 2022 and December 2022. Using consecutive convenient sampling, the research enrolled 220 pregnant women. The urine samples obtained from these women were cultured on MacConkey and blood agar and incubated at 37°C overnight, followed by sub-culturing on Mueller Hinton media. Bacterial identification involved Gram staining and biochemical characterization (TSI, indole, citrate, methyl red, urea agar, and motility tests). Conversely, susceptibility tests were performed using the Kirby-Bauer disk diffusion method. A binary logistic regression model and analysis of odds ratios (ORs) were employed to evaluate the risk factors associated with E. coli infection, and statistical significance was attributed to p-values of ≤0.05. Results: Out of the 220 urine samples examined, 42 (19%) exhibited a positive culture, indicating an E. coli infection in pregnant women. Our analysis revealed that income, gestational age, and history of UTIs were identified as risk factors associated with E. coli infection. Most E. coli isolates demonstrated sensitivity to amikacin (100%), nitrofurantoin (85.7%), amoxicillin/clavulanic acid, and meropenem (83.3%). Conclusion: The prevalence of E. coli was remarkable. It could be recommended that pregnant women in antenatal care have routine culture and antimicrobial susceptibility tests to prevent transmission of resistant pathogens and complications in both pregnant mothers and the unborn baby.

Assessment of climate change effects on vegetation and river hydrology in a semi-arid river basin.

Climate change plays a key role in changing vegetation productivity dynamics, which ultimately affect the hydrological cycle of a watershed through evapotranspiration (ET). Trends and correlation analysis were conducted to investigate vegetation responses across the whole Upper Jhelum River Basin (UJRB) in the northeast of Pakistan using the normalized difference vegetation index (NDVI), climate variables, and river flow data at inter-annual/monthly scales between 1982 and 2015. The spatial variability in trends calculated with the Mann-Kendall (MK) trend test on NDVI and climate data was assessed considering five dominant land use/cover types. The inter-annual NDVI in four out of five vegetation types showed a consistent increase over the 34-year study period; the exception was for herbaceous vegetation (HV), which increased until the end of the 1990s and then decreased slightly in subsequent years. In spring, significant (p<0.05) increasing trends were found in the NDVI of all vegetation types. Minimum temperature (Tmin) showed a significant increase during spring, while maximum temperature (Tmax) decreased significantly during summer. Average annual increase in Tmin (1.54°C) was much higher than Tmax (0.37°C) over 34 years in the UJRB. Hence, Tmin appears to have an enhancing effect on vegetation productivity over the UJRB. A significant increase in NDVI, Tmin and Tmax during spring may have contributed to reductions in spring river flow by enhancing evapotranspiration observed in the watershed of UJRB. These findings provide valuable information to improve our knowledge and understanding about the interlinkages between vegetation, climate and river flow at a watershed scale.

COVID-19 Vaccine Coverage and Potential Drivers of Vaccine Uptake among Healthcare Workers in SOMALIA: A Cross-Sectional Study.

Healthcare workers (HCWs) are one of the most vulnerable groups for contracting COVID-19 and dying as a result of it. Over 10,000 HCWs in Africa have been infected with COVID-19, according to the World Health Organization, making it a substantial occupational health threat for HCWs. To that end, Somalia's Ministry of Health has ordered that all healthcare personnel obtain the COVID-19 vaccination to safeguard themselves and the community they serve. In this investigation, we aimed to assess the COVID-19 vaccination coverage and its associated factors among healthcare workers in Somalia. A cross-sectional study was employed to examine COVID-19 vaccination coverage among healthcare personnel in Somalia. The data were obtained via an online questionnaire supplied by Google forms between December 2021 and February 2022, where a total of 1281 healthcare workers from the various federal states of Somalia were recruited. A multinomial regression analysis was used to analyse the factors associated with COVID-19 vaccine uptake. Overall, 1281 HCWs participated (630 females, 651 males) with a mean age and standard deviation of 27.7 years ± 7.1. The overall vaccine coverage was 37.4%. Sex, age, the state of residency, education level, specialization, hospital COVID-19 policy, vaccine availability at the centre, COVID-19 treatment centre, and health facility level were the factors that influenced the COVID-19 vaccine uptake among health professionals in Somalia. Male healthcare employees were 2.2 times (odds ratio-OR = 2.2; confidence interval-CI: 1.70, 2.75, p < 0.001) more likely than female healthcare workers to be fully vaccinated. The survey discovered that the COVID-19 vaccine coverage among health professionals was quite low, with the major contributing factors being accessibility, security challenges and literary prowess. Additional efforts to enhance vaccination uptake are needed to improve the COVID-19 vaccination coverage.

Seroprevalence of SARS-CoV-2 virus antibodies and sociodemographic features of pregnant women in Mogadishu, Somalia: a cross-sectional survey study.

OBJECTIVE: Recent investigations have revealed that COVID-19 during pregnancy substantially increases the risk of harmful outcomes for mothers and neonates, including preterm death and stillbirth as well as severe maternal morbidity and mortality. Hence, the urgent need to understand the prevalence rate and level of awareness about COVID-19 (SARS-CoV-2 virus infection) and the practice of preventive measures against the disease among pregnant women in Somalia. This study aims to determine the prevalence of COVID-19 among pregnant women seeking antenatal care in the Benadir region (Mogadishu) of Somalia and to assess their knowledge and preventive practices towards COVID-19. SETTING: A hospital-based cross-sectional study involving two major referral maternity hospitals in Mogadishu, Somalia. PARTICIPANTS: Pregnant women seeking antenatal services were included in our study. METHODS: A total of 477 blood samples were collected from pregnant women attending the two referral hospitals in Mogadishu and screened for COVID-19. The participants were subjected to questionnaire interviews where their detailed history and practice of prevention against COVID-19 were evaluated. RESULTS: The results showed that 175 (36.7%) were positive while 302 (63.3%) samples were negative for SARS-CoV-2 virus antibodies. Also, out of the 141 pregnant women who had two children or less, 19.4% were positive for IgG/IgM antibodies. Participants who had close contact with patients with COVID-19 were significantly associated for testing positive with a p value 0.0001. Students, teachers, employed people and individuals reported COVID-19 like symptoms were all associated with COVID-19 seropositivity outcomes. CONCLUSION: Pregnant women and those with commorbidies should be given special preventive care and health education about COVID-19 transmission.

The differential impact of pediatric COVID-19 between high-income countries and low- and middle-income countries: A systematic review of fatality and ICU admission in children worldwide.

BACKGROUND: The overall global impact of COVID-19 in children and regional variability in pediatric outcomes are presently unknown. METHODS: To evaluate the magnitude of global COVID-19 death and intensive care unit (ICU) admission in children aged 0-19 years, a systematic review was conducted for articles and national reports as of December 7, 2020. This systematic review is registered with PROSPERO (registration number: CRD42020179696). RESULTS: We reviewed 16,027 articles as well as 225 national reports from 216 countries. Among the 3,788 global pediatric COVID-19 deaths, 3,394 (91.5%) deaths were reported from low- and middle-income countries (LMIC), while 83.5% of pediatric population from all included countries were from LMIC. The pediatric deaths/1,000,000 children and case fatality rate (CFR) were significantly higher in LMIC than in high-income countries (HIC) (2.77 in LMIC vs 1.32 in HIC; p < 0.001 and 0.24% in LMIC vs 0.01% in HIC; p < 0.001, respectively). The ICU admission/1,000,000 children was 18.80 and 1.48 in HIC and LMIC, respectively (p < 0.001). The highest deaths/1,000,000 children and CFR were in infants < 1 year old (10.03 and 0.58% in the world, 5.39 and 0.07% in HIC and 10.98 and 1.30% in LMIC, respectively). CONCLUSIONS: The study highlights that there may be a larger impact of pediatric COVID-19 fatality in LMICs compared to HICs.

Correction to: The accuracy and reliability of digital measurements of gingival recession versus conventional methods.

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The accuracy and reliability of digital measurements of gingival recession versus conventional methods.

BACKGROUND: An apical shift in the position of the gingiva beyond the cemento-enamel junction leads to gingival recession. This study aimed to evaluate the reproducibility of digital measurements of gingival recession when compared to conventional measurements taken clinically using periodontal probes. METHODS: Gingival recession was measured at 97 sites in the oral cavity by four examiners using the following methods: CP, direct measurement of gingival recession using William's periodontal probe intraorally; CC, measurements on cast models using a caliper; DP, digital measurement on virtual models obtained by intraoral scanning, and DC, digital measurements on virtual models of dental casts. Intra-class and inter-rater correlations were analyzed. Bland Altman plots were drawn to visually determine the magnitude of differences in any given pair-wise measurements. RESULTS: In this study, good inter-methods reliability was observed for almost all the examiners ranging from 0.907 to 0.918, except for one examiner (0.837). The greatest disagreements between the raters were observed for methods; CP (0.631) followed by CC (0.85), while the best agreements were observed for methods DP (0.9) followed by DC (0.872). CONCLUSION: Variations in measurements between examiners can be reduced by using digital technologies when compared to conventional methods. Improved reproducibility of measurements obtained via intraoral scanning will increase the validity and reliability of future studies that compare different treatment modalities for root coverage.

Effect of patient age on treatment response in a study of the acute exacerbation of psychosis in schizophrenia.

Younger patients with schizophrenia have most likely experienced fewer adverse consequences of the illness than older patients who may have experienced a lifetime of treatment as well as socio-economic problems as a consequence of the illness. There is limited information regarding differential efficacy of long-acting injectable (LAI) antipsychotic medications across the age span in patients with schizophrenia. We conducted a post hoc age and gender analysis of treatment response to aripiprazole lauroxil (AL; ARISTADA®; Alkermes, Inc.), in a 12-week, double-blind, placebo-controlled, multinational, Phase 3 study evaluating two doses of AL (441mg and 882mg) versus placebo in adult patients experiencing an acute exacerbation of schizophrenia within the previous 2months. We examined change in the total Positive and Negative Syndrome Scale (PANSS) scores from baseline using analysis of covariance and categorical treatment response (defined as ≥30% total PANSS score improvement from baseline) in the following age groups: <30, 30-39, 40-49, and 50-69years old. Age and gender did not moderate the treatment response in this study. Both AL 441mg and AL 882mg showed an early and significant improvement of the mean total PANSS scores and categorical treatment responses compared to placebo in all four age groups, including younger patients regardless of gender that was sustained over the 85-day treatment period.

Correction of Buccal Dehiscence During Immediate Implant Placement Using the Flapless Technique: A Tomographic Evaluation.

BACKGROUND: The aim of this study was to evaluate a new technique for treating dehiscence buccal bone sites (Class II) with immediate implant and collagen-enriched bovine-derived xenograft blocks without a surgical flap or membrane. METHODS: Individuals with at least 5 mm of buccal bone dehiscence were selected for a flapless surgical approach to insert xenograft blocks into buccal dehiscence defects as well as the gap between implant and residual bone wall. No membrane was used. Buccal bone wall height was measured by computed tomography in the preoperative period (T0) and 6 to 12 months after procedure (T1). Likewise, buccal-lingual width of alveolar ridge as well as thickness of buccal wall was compared with the contralateral tooth. RESULTS: Fourteen patients were selected. Buccal wall height at T1 was not significantly different after 6 to 12 months between the treated and contralateral teeth, although both were greater than T0 (P <0.01). The heights ranged from 6.4 to 16.30 mm at T0, 12.8 to 25.6 mm at T1, and 14.8 to 25.29 mm in the contralateral teeth. Significant differences were observed between treated teeth (T1) and their contralateral, both buccal-lingually in the alveolar ridge (P = 0.007) and in buccal wall thickness (P = 0.003). Wall thickness ranged from 0.9 mm to 3.81 mm at T1 and 0.25 mm to 1.60 mm in the contralateral teeth. CONCLUSION: Immediate implant placement at dehiscence buccal bone sites using flapless surgery combined with xenograft blocks provided complete formation of the buccal bone wall up to the implant shoulder.

Associations of recurrent miscarriages with chromosomal abnormalities, thrombophilia allelic polymorphisms and/or consanguinity in Saudi Arabia.

BACKGROUND: Recurrent pregnancy loss (RPL) or recurrent spontaneous abortion is an obstetric complication that affects couples at reproductive age. Previous reports documented a clear relationship between parents with chromosomal abnormalities and both recurrent miscarriages and infertility. However, limited data is available from the Arabian Peninsula which is known by higher rates of consanguineous marriages. The main goal of this study was to determine the prevalence of chromosomal abnormalities and thrombophilic polymorphisms, and to correlate them with RPL and consanguinity in Saudi Arabia. METHODS: Cytogenetic analysis of 171 consent patients with RPL was performed by the standard method of 72-h lymphocyte culture and GTG banding. Allelic polymorphisms of three thrombophilic genes (Factor V Leiden, Prothrombin A20210G, MTHFR C677T) were performed using PCR-RFLP (restriction fragment length polymorphism) and gel electrophoresis. RESULTS: Data analysis revealed that 7.6 % of patients were carrier of numerical or structural chromosomal abnormalities. A high rate of translocations (46 %) was associated to increased incidence of RPL. A significant correlation between consanguineous RPL patients and chromosomal abnormalities (P < 0.05) was found. Both Factor V Leiden and Prothrombin A20210G allelic polymorphisms were significantly associated with a higher prevalence of RPL. CONCLUSIONS: This study demonstrated a strong association between RPL and the prevalence of chromosomal abnormalities and inherited thrombophilia. Given the high rate of consanguineous marriages in the Saudi population, these results underline the importance of systematic cytogenetic investigation and genetic counseling preferably at the premarital stage or at least during early pregnancy phase through preimplantation genetic diagnosis (PGD).

Orthodontic treatment of a mandibular incisor fenestration resulting from a broken retainer.

This article describes the orthodontic relapse with mandibular incisor fenestration in a 36-year-old man who had undergone orthodontic treatment 21 years previously. The patient reported that his mandibular 3 × 3 bonded retainer had been partially debonded and broken 4 years earlier. The mandibular left lateral incisor remained bonded to the retainer and received the entire load of the incisors; consequently, there was extreme labial movement of the root, resulting in dental avulsion. As part of the treatment, the root was repositioned lingually using a titanium-molybdenum segmented archwire for 8 months, followed by endodontic treatment, an apicoectomy, and 4 months of alignment and leveling of both arches. The treatment outcomes were excellent, and the tooth remained stable, with good integrity of the mesial, distal, and lingual alveolar bones and periodontal ligament. The 1-year follow-up showed good stability of the results.

Computed tomographic evaluation of alterations of the buccolingual width of the alveolar ridge after immediate implant placement associated with the use of a synthetic bone substitute.

PURPOSE: To evaluate the alterations of the buccolingual width of the alveolar ridge after immediate implant placement using a fully synthetic biphasic calcium phosphate (BCP) consisting of a mixture of 60% hydroxyapatite and 40% ?-tricalcium phosphate in esthetic regions. MATERIALS AND METHODS: The buccolingual widths of the alveolar ridge in 20 extraction sites in 20 patients were assessed using computed tomography. Measurements were performed before and 6 months after extractions and immediate implant placement. In group 1 (11 patients), BCP was in the space between the buccal wall of the alveolar ridge and implant. In group 2 (9 patients), the same evaluations and procedures were performed but without using BCP. RESULTS: The buccolingual dimensions of the alveolar ridge in group 1 (BCP) showed no significant preoperative differences (8.49 ± 1.1 mm) during the 6-month period after surgery (8.82 ± 0.9 mm) (P = .14). In group 2, the differences in buccolingual dimensions of the alveolar ridge were statistically significant (P = .01) with reduction in dimensions from 8.12 ± 0.7 mm during the preoperative period to 7.01 ± 0.4 mm 6-months after surgery. CONCLUSION: The use of BCP was effective in preserving buccolingual dimensions of alveolar ridges in immediate implant surgeries.

Early weight gain as a predictor of substantial weight gain with olanzapine/fluoxetine combination: an analysis of 2 adult studies in treatment-resistant depression.

Weight gain during olanzapine/fluoxetine combination (OFC) therapy is very common. We examined early (at 2 weeks) weight gain as a predictor of later (at 26 weeks) substantial weight gain in patients with treatment-resistant depression during OFC pharmacotherapy. Data were analyzed from 2 studies (Study 1 and Study 2)-each with an acute, double-blind phase and an open-label phase-in patients who completed 26 weeks of open-label treatment (N = 306). Mean patient age was 46 years; the majority was female and white. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were examined using early weight gain of 2 kg or more as a predictor of 10 kg or more substantial weight gain. Sensitivity (true positive rate) and specificity for Study 1 (n = 73) were 33% and 71%, respectively; PPV and NPV were 23% and 80%, respectively. Sensitivity and specificity for Study 2 (n = 233) were 52% and 70%, respectively; PPV and NPV were 31% and 85%, respectively. Overall, in the 2 trials analyzed, for patients who did not gain 2 kg or more (2.54 lb) in the first 2 weeks of OFC treatment, the observed frequency was 16.3% for gaining 10 kg or more at 26 weeks. Compared to those with early weight gain, patients without early weight gain were less likely to have substantial weight gain after OFC treatment. Additional research is needed to further explore the predictive power of early weight gain for subsequent substantial weight gain in patients with treatment-resistant depression treated with OFC.

Relationship between African-American or Caucasian origin and outcomes in the olanzapine treatment of acute mania: a pooled analysis of three adult studies conducted in the United States of America.

The aim of this study was to explore the role of ethnic origin in the treatment of acute bipolar mania. Treatment outcomes were studied in a post-hoc analysis of African-American (AA, n=41) and Caucasian (CA, n=190) adults treated with olanzapine in three studies conducted in the United States of America. Baseline demographics were similar except that the AA cohort had fewer women compared with the CA cohort (37 vs. 58%; P=0.01). Daily mean modal olanzapine dose and study discontinuation rate for AA and CA were: 16.2 mg vs. 16.6 mg and 41.5 vs. 25.3% (P=0.03), respectively. There were four (23.5% of discontinuers) and 19 (39.6% of discontinuers, P=0.14) discontinuations because of a poor response in the AA and CA groups, respectively. Drug exposure for the AA cohort was 18.7 days and that of the CA cohort was 19.3 days. Both cohorts showed similar symptom improvements, and safety outcomes were not statistically significantly different except for the following treatment-emergent adverse event frequencies for AA and CA cohorts, respectively: agitation (24.4 vs. 10.5%, P=0.04); dysmenorrhoea (20.0 vs. 3.6%, P=0.04); and dizziness postural (7.3 vs. 1.1%, P=0.04). Although study findings [limited by a smaller (18% of total population) AA cohort] need replication, they suggest that while many outcomes were similar in both cohorts, clinicians could benefit from the awareness of factors in the AA population that possibly influence study discontinuation rates, treatment-emergent adverse event reporting, and participation by sex.