Impact of weather conditions on incidence and mortality of COVID-19 pandemic in Africa.

OBJECTIVE: The weather-related conditions change the ecosystem and pose a threat to social, economic and environmental development. It creates unprecedented or unanticipated human health problems in various places or times of the year. Africa is the world's second largest and most populous continent and has relatively changeable weather conditions. The present study aims to investigate the impact of weather conditions, heat and humidity on the incidence and mortality of COVID-19 pandemic in various regions of Africa. MATERIALS AND METHODS: In this study, 16 highly populated countries from North, South, East, West, and Central African regions were selected. The data on COVID-19 pandemic including daily new cases and new deaths were recorded from World Health Organization. The daily temperature and humidity figures were obtained from the weather web "Time and Date". The daily cases, deaths, temperature and humidity were recorded from the date of appearance of first case of "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" in the African region, from Feb 14 to August 2, 2020. RESULTS: In African countries, the daily basis mean temperature from Feb 14, 2020 to August 2, 2020 was 26.16±0.12°C, and humidity was 57.41±0.38%. The overall results revealed a significant inverse correlation between humidity and the number of cases (r= -0.192, p<0.001) and deaths (r= -0.213, p<0.001). Similarly, a significant inverse correlation was found between temperature and the number of cases (r= -0.25, p<0.001) and deaths (r=-0.18, p<0.001). Furthermore, the regression results showed that with 1% increase in humidity the number of cases and deaths was significantly reduced by 3.6% and 3.7% respectively. Congruently, with 1°C increase in temperature, the number of cases and deaths was also significantly reduced by 15.1% and 10.5%, respectively. CONCLUSIONS: Increase in relative humidity and temperature was associated with a decrease in the number of daily cases and deaths due to COVID-19 pandemic in various African countries. The study findings on weather events and COVID-19 pandemic have an impact at African regional levels to project the incidence and mortality trends with regional weather events which will enhance public health readiness and assist in planning to fight against this pandemic.

Novel coronavirus 2019-nCoV: prevalence, biological and clinical characteristics comparison with SARS-CoV and MERS-CoV.

OBJECTIVE: Human infections with zoonotic coronavirus contain emerging and reemerging pathogenic characteristics which have raised great public health concern. This study aimed at investigating the global prevalence, biological and clinical characteristics of novel coronavirus, Wuhan China (2019-nCoV), Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection outbreaks. MATERIALS AND METHODS: The data on the global outbreak of "2019-nCoV, SARS-CoV, and MERS-CoV" were obtained from World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), concerned ministries and research institutes. We also recorded the information from research documents published in global scientific journals indexed in ISI Web of Science and research centers on the prevalence, biological and clinical characteristics of 2019-nCoV, SARS-CoV, and MERS-CoV. RESULTS: Worldwide, SARS-CoV involved 32 countries, with 8422 confirmed cases and 916 (10.87%) casualties from November 2002 to August 2003. MERS-CoV spread over 27 states, causing 2496 cases and 868 (34.77%) fatalities during the period April 2012 to December 2019. However, the novel coronavirus 2019-nCoV spread swiftly the global borders of 27 countries. It infected 34799 people and resulted in 724 (2.08%) casualties during the period December 29, 2019 to February 7, 2020. The fatality rate of coronavirus MERS-CoV was (34.77%) higher than SARS-CoV (10.87%) and 2019-nCoV (2.08%); however, the 2019-nCoV transmitted rapidly in comparison to SARS-CoV and MERS-CoV. CONCLUSIONS: The novel coronavirus 2019-nCoV has diverse epidemiological and biological characteristics, making it more contagious than SARS-CoV and MERS-CoV. It has affected more people in a short time period compared to SARS-CoV and MERS-CoV, although the fatality rate of MERS-CoV was higher than SARS-CoV and 2019-nCoV. The major clinical manifestations in coronavirus infections 2019-nCoV, MERS-CoV, and SARS CoV are fever, chills, cough, shortness of breath, generalized myalgia, malaise, drowsy, diarrhea, confusion, dyspnea, and pneumonia. Global health authorities should take immediate measures to prevent the outbreaks of such emerging and reemerging pathogens across the globe to minimize the disease burden locally and globally.

Unusual cause of bilateral vocal cord paralysis.

The most common cause of vocal cord paralysis (VCP) as a result of recurrent laryngeal nerve compression is malignant tumors. A benign and inflammatory causes of VCP is rarely reported in the literature, and in almost all reported cases it was a unilateral paralysis. We report a rare case of tuberculous mediastinal lymphadenopathy causing bilateral VCP in a young female patient.

Unusual case of inhaled metallic dental bur during dental procedure in a healthy adult.

Bronchial foreign body aspiration (BFBA) is not a rare incident in children. It can be managed successfully with flexible bronchoscopy in most of the cases, except for some cases, which require rigid bronchoscopy or even surgical intervention such as thoracotomy. Here, we report an unusual case of BFBA of metallic dental bur in a healthy 24-year-old dental nurse assistant, who was herself undergoing a dental procedure to remove dental caries, and suddenly the foreign body which was "diamond metallic dental bur" has slipped into her mouth and was aspirated to the bronchial tree. It was successfully removed 5 days after the incident using rigid and fiberoptic bronchoscopy with full recovery.

Knowledge, Attitudes, and Beliefs Toward Organ Donation Among Social Media Users.

BACKGROUND: Organ transplantation is the optimal treatment for end-stage organ diseases. The demand for organs has exceeded the available supply, which becomes a major obstacle worldwide. Identifying the factors affecting this gap will help in overcoming this obstacle. The purpose of the work was to study the knowledge, attitudes, and beliefs of organ donation and to determine the knowledge of brain death among social media users. METHODS: A cross-sectional study was conducted among social media users living in Saudi Arabia. A pre-designed self-administrated questionnaire was distributed online randomly on social media networks in 2015. Of the total 1368 participants, only 913 met the criteria. RESULTS: Most respondents were between 18 and 29 years of age (61.2%) and living in the central region of Saudi Arabia (64.5%). The majority of respondents received their information from television (57%) and social media (50%) networks; 46.4% of respondents knew that the religious fatwa allowed organ donation; 51% of respondents were willing to donate their organs; 46.5% considered the brain-dead to be deceased, whereas 37.7% considered it a coma; 33.3% did not know if someone who was brain-dead would ever wake up; on the other hand, 323 (35.4%) said yes. CONCLUSIONS: Our study showed that the vast majority of our sample had enough information about organ donation. On the contrary, they had minimal knowledge about brain death. Moreover, a fair percentage of the participants had positive attitudes toward organ donation. Also, the media had a significant effect on the information about organ donation and brain death.

Percutaneous tracheotomy: Forceps vs. cone dilatation techniques.

BACKGROUND: Percutanoeous tracheotomy (PT) is a minimal invasive procedure alternative to surgical tracheotomy. PT offers an added advantage of enormous decrease of time interval between decision of doing tracheotomy and actually doing it. Moreover hazards of patient transport can be avoided as it can be safely performed at the bedside. We started doing PT in 2003 and performed 100 cases using forceps dilatation. Later we switched over to cone dilatation where we performed 215 cases. This study aims to compare two techniques of forceps vs. cone dilatation methods for PT. METHODS: A total of 100 cases of PT were performed starting from December 2003 to August 2005 using the forceps dilatation method (group A). Further 215 cases were conducted (group B) from September 2003 to July 2008 using the cone dilatation method. Time of performing both procedures was recorded. Also incidence of complications was also recorded in both groups. RESULTS: The incidence of minor bleeding in group A was 9%, whereas in group B was 5.58%. Major bleeding occurred in two patients in group B. Both cases suffered of pneumothorax and emphysema. One patient developed life-threatening tension pneumothorax and required cardio pulmonary resuscitation. This was one case in this series, in which the procedure has contributed to patient's morbidity. Guide wire-related technical difficulties were seen in 2% of the cases in group A, and 3.7% of cases in group B. CONCLUSION: forceps dilatation PT is superior to the cone dilatation technique in terms of safety. Further studies are needed to confirm our results.

Life threatening complications caused by bronchogenic and oesophageal duplication cysts in a child.

An 11-year-old girl presented with severe respiratory distress, fever and septic manifestations. Computed tomography scan (CT) of the chest showed 2 separate superior and posterior mediastinal cysts, the upper one causing severe extrinsic compression of the trachea, and the oesophagus, while the lower cyst was at the subcarinal region compressing the 2 major bronchi. Emergency thoracotomy was performed permitting complete resection of intra-mural oesophageal enteric cyst, and a subcarinal bronchogenic cyst. The postoperative course was uneventful.

Pulmonary metastatectomy for soft tissue sarcomas: is it valuable?

BACKGROUND: A retrospective study and analysis was performed to determine the value and benefit of pulmonary metastatectomy for soft tissue sarcomas, and which factors predict prognosis following resection. METHODS: Twenty-three patients underwent resections for pulmonary metastases from a soft tissue sarcoma (STS) at King Faisal Specialist Hospital and Research Center (KFSH&RC), between January 1985 and December 1998. There were 11 male and 12 female patients. Thirteen of 23 patients (57%) had one to three metastases, and 10 (43%) had four or more metastases. A total of 41 thoracic explorations was performed for the 23 evaluable patients. Median sternotomy was used only for three patients and lateral thoracotomy was used for 20 patients as an initial surgical approach. Pulmonary resections performed included one or more wedge resections (n=16), segmentectomy (n=5), and lobectomy (n=2). No one in this series underwent pneumonectomy. The number of resected metastatic nodules ranged from one-six with average three. Eight patients (35%) received various kinds of postoperative adjuvant chemotherapy. RESULTS: The overall and disease-free survival rate post-metastatectomy at five years was 24% and 21%, respectively. Various prognostic indicators were examined to evaluate their association with improved survival. Age, sex localization of the primary site and histologic type, tumor grade, size of the resected nodules, laterality (unilateral or bilateral), types of resection, adjuvant chemotherapy, and local recurrence did not significantly affect survival. However, patient with disease free interval >6 months, and those with three or fewer metastases showed a trend toward a higher five-year overall survival (p=0.06, 0.07, respectively). CONCLUSIONS: Surgical excision of lung metastases from soft tissue sarcomas is well accepted and should be considered as a first line of treatment if preoperative evaluation indicated that complete resection of the metastases is possible. Further investigation is needed before chemotherapy can be recommended as additional therapy.

Surgery for pulmonary aspergilloma in post-tuberculous vs. immuno-compromised patients.

OBJECTIVE: To compare the outcome of surgical resection for aspergilloma between patients with post-tuberculous complex and neutropenia. METHODS: We retrospectively reviewed our surgical experience with pulmonary resection for aspergilloma in 30 patients. Of the 20 patients with complex aspergilloma complicating healed tuberculosis (group 1), 14 were male and six were female with an average age of 54 years (SD 7). The indication for surgery was recurrent haemoptysis in all and there were 17 lobectomies, two pneumonectomies and one bilateral lobectomy. There were ten patients with acute myeloid or lymphoid leukemia (group 2), six male and four female with an average age of 26 years (SD 4). Twelve lesions required lobectomy in eight and wedge excision in four. RESULTS: In group 1 there was one post-operative death (5%), in a patient with massive haemoptysis and completely destroyed lungs with bilateral upper lobe aspergilloma secondary to pneumonia. Morbidity accounted for 25% (five patients), two required re-exploration for bleeding, two had prolonged air leak more than 7 days and one developed empyema. The later was treated with drainage and rib resection. One patient had recurrence of haemoptysis during the follow up period (mean 42 months). In group 2 there was no mortality or morbidity and six patients proceeded to bone marrow transplantation with no complication or recurrence. CONCLUSIONS: Surgical resection for pulmonary aspergilloma in selected patients provides the best chance of cure. Pulmonary resection for post-tuberculous complex aspergilloma is associated with higher morbidity than resection for immuno-compromised patients.

Endobronchial inflammatory pseudotumor of the lung.

Inflammatory pseudotumor (also called plasma cell granuloma, histiocytoma and x-anthofibroma) is a benign, slow growing lesion which may present with cough, dyspnea, hemoptysis and unresolving pneumonia or can be discovered radiographically as a localised lesion. It has been reported in individuals up to 70 years old, but approximately two-thirds have developed in individuals under 30 years of age. The sex incidence is approximately equal. Inflammatory pseudotumors of the lung are usually peripheral lesions but may occasionally be endobronchial. We report the case of an endobronchial inflammatory pseudotumor in a 17-year-old girl who presented with unresolving right-sided pneumonia. Appropriate radiological, bronchoscopic and histopathological investigations lead to accurate pre-operative diagnosis and early complete surgical resection through a limited right main bronchus incision (bronchotomy). The patient made good postoperative recovery and an excellent prognosis is anticipated.

Spontaneous chylothorax--case report.

A-19-year old male patient complained of shortness of breath. Aspiration of the pleural fluid revealed chylothorax. Right chest tube was inserted. His ABG showed hypoxaemia with relative hypercarbia. He underwent right thoracotomy and thoracic duct ligation under general anaesthesia and double lumen endobroncheal intubation. During surgery he lost 1.5 L of blood and 4 L chyle. He was transferred to the SICU intubated and on mechanical ventilation. On the subsequent days chyle leak was reduced to a minimum of 10 ml/hr. On the 9th postoperative day the patient was extubated. He was receiving TPN 2600 kcal/day. He was transferred to the normal floor on the 15th day. After 7 day he was readmitted, his chest showed severe lung fibrosis and consolidation. His ABG showed severe hypercarbia (PaCO2 = 126 mmHg). The patient was intubated. His condition deteriorated and he was considered for lung transplantation. No donor was available. Later he arrested and died. Anaesthesia and surgical management of spontaneous chylothorax is challenging. The mortality rate is high.

Current surgical therapy for bronchiectasis.

The ideal classification system for bronchiectasis continues to be debated. As an alternative to the present morphologic classification, a hemodynamic-based functional classification is proposed. This study examines the rationale for and outcome of surgery based on this classification in patients with unilateral or bilateral bronchiectasis. Between July 1987 and January 1997 the morphologic and hemodynamic features in 85 bronchiectatic patients were examined: 18 with bilateral bronchiectasis and 67 with unilateral disease. A policy of unilateral lung resection of the nonperfused bronchiectasis and preservation of the perfused type was adopted in all patients. The mean age at operation was 29.4 +/- 9.7 years (range 6-55 years) with a mean follow-up period of 45.2 +/- 21.0 months (range 2-120 months). Left-sided predominance of bronchiectasis was evident in this series both in frequency and severity. In those with unilateral disease, bronchiectasis was left-sided in 49 (73.1%) patients and right-sided in 18 (26.9%). The left lung was totally bronchiectatic in 11 (16.4%) patients and the right in 3 (4.4%). Moreover, among the patients with bilateral bronchiectasis, 14 of 18 (77.7%) patients had the left lung more severely involved. Based on the morphologic and hemodynamic features in the investigated patients, two types of bronchiectasis were recognized: a perfused type with intact pulmonary artery flow and a nonperfused type with absent pulmonary artery flow. Lobectomy was performed in 55 patients, basal segmentectomy and preservation of the apical segment in 16, and pneumonectomy in 14. There was no mortality in this series. Altogether 63 patients (74.1%) achieved excellent results, 19 (22.4%) scored good results, and 3 (3.5%) patients had not benefited from surgery at last follow-up. In the face of the general criticism of the traditional morphologic classification, the proposed classification not only predicts whether the involved lung will have a measure of respiratory function with regard to gas exchange but reflects the degree of severity of the disease process. Thus the question of which side to resect and which to preserve is defined more precisely. This classification was found to be logical, physiologically sound, and of proven benefit.

Primary sternal tuberculosis treated by resection and reconstruction.

We report a case of primary mycobacterial sternal infection. An 81-year-old man with an infected parasternal sinus of non-specific pathology was treated with antibiotics for four months with only palliative effect. On hospital admission CT scan showed thickened first and second intercostal spaces and chest wall, but no bone involvement. At operation, the manubrium was found to be infected also. This was excised with the first three ribs anteriorly. Histology showed caseating granulomata. No other tuberculous foci were found in the patient.

Noninvasive diagnosis of extracranial carotid arterial disease: a prospective evaluation of pulsed-Doppler imaging and oculoplethysmography.

Two hundred consecutive internal carotid arteries were examined with the Hokanson-pulsed Doppler ultrasonic arteriograph (UA) and the Kartchner-McCrae oculoplethysmograph (OPG). Roentgenographic studies were used to assess the relative accuracy of these two noninvasive tests. Diameter stenoses estimated from the UA and roentgenographic images agreed within +/- 20% in 81% of the studies. The UA detected 61% of all stenoses of 20% to 39% and 89% of all stenoses greater than 40%. A sensitivity of 86% and a specificity of 90% were achieved with the UA compared with a sensitivity of 64% and a specificity of 85% with the OPG. When the UA and OPG agreed (67% of the vessels), the sensitivity was 95% and the specificity was 94%. When they disagreed, the UA was the better test having a sensitivity of 81% compared with 21% with the OPG.

Noninvasive diagnosis of neonatal asphyxia and intraventricular hemorrhage by Doppler ultrasound.

The cerebrovascular hemodynamic alterations in asphyxia and intracerebral-intraventricular hemorrhage were determined by monitoring the pulsatile flow changes in the anterior cerebral arteries using Doppler ultrasound. The pulsatility index measurements, which were calculated from the recorded changes in Doppler frequency shifts, were obtained in four groups of newborn infants with the following diagnoses: Group I--normal term (n=21); Group II--asphyxia (n=12); Group III--IC-IVH (n=14); and Group IV--asymptomatic preterm (n=11). There was no significant difference between PI values of Groups I and IV. Compared to normal term infants, those diagnosed as having asphyxia had significantly lower PI measurements and those with IC-IVH had significantly higher PI values than the asymptomatic pretern infants. Serial Doppler studies were also performed in 22 preterm infants with respiratory distress. One-half of these infants subsequently developed IC-IVH. Prior to hemorrhage, their PI measurements were significantly lower than those who did not eventually have the complication. The low PI values in asphyxia and prior to the onset of IC-IVH indicate vasodilation and decreased resistance to blood flow. In IC-IVH, the high PI measurements denote the opposite. In infants with respiratory distress in the presence of significant vasodilation and lowered vascular resistance, CBF may increase to excessive levels, resulting in IC-IVH.

The fontogram: a noninvasive intracranial pressure monitor.

The applanation transducer was used to measure intracranial pressure (ICP) through the intact fontanel. The method is painless, rapid, and accurate. The pressures recorded with this fontogram were correlated with direct measurements of ICP. The correlation coefficient of the 21 paired determinations was .98--a very good correlation. Fontanel pressure was determined in 35 normal newborn infants. The mean pressure was 7.37 mm Hg with an SD of +/- 1.45 (range, 3.5 to 9.5 mm Hg). Three clinical cases are presented to illustrate the usefulness of this apparatus in the detection of increased ICP and in monitoring the effectiveness of treatment.

Measurement of the acoustic properties of a nerve-muscle preparation as a function of physiologic state.

Nerve-muscle preparations of Sprague Dawley rats were exposed to low dosage ultrasound. The objectives were to measure the velocity of propagation and attenuation of ultrasonic energy in both the relaxed and contracted states. A tension-measuring system and associated ultrasonic instrumentation were designed to measure the tension developed in stimulated muscle and its corresponding acoustic parameters, ie the attenuation coefficient, alpha (db cm-1) and the velocity of propagation, c (ms-1). Each test was performed at ultrasonic frequencies 3.1, 5.35, and 7.68 MHz and with the preparation maintained at 23 +/- 0.5 degrees C. Attenuation of ultrasonic energy was observed to increase by 10 +/- 0.5% in the active state from its value in the relaxed state. The relation between the attenuation and the acoustic frequency was found to be approximately linear over the frequency range tested. The velocity of propagation in the active state did not change appreciably from its value in the relaxed state and was observed to be independent of the acoustic frequency in the range used.