The efficacy of biosynthesized silver nanoparticles against Pseudomonas aeruginosa isolates from cystic fibrosis patients.

The high antibiotic resistance of Pseudomonas aeruginosa (PA) makes it critical to develop alternative antimicrobial agents that are effective and affordable. One of the many applications of silver nanoparticles (Ag NPs) is their use as an antimicrobial agent against bacteria resistant to common antibiotics. The key purpose of this research was to assess the antibacterial and antibiofilm effectiveness of biosynthesized Ag NPs against six biofilm-forming clinically isolated strains of PA and one reference strain (ATCC 27853). Ag NPs were biosynthesized using a seed extract of Peganum harmala as a reducing agent. Ag NPs were characterized by Ultraviolet-visible (UV-Vis) spectroscopy and scanning transmission electron microscopy (STEM). The effect of Ag NPs on biofilm formation and eradication was examined through micro-titer plate assays, and the minimal inhibitory (MIC) and minimum bactericidal (MBC) concentrations determined. In addition, real-time polymerase chain reactions (RT-PCR) were performed to examine the effects of Ag NPs on the expression of seven PA biofilm-encoding genes (LasR, LasI, LssB, rhIR, rhII, pqsA and pqsR). The biosynthesized Ag NPs were spherically-shaped with a mean diameter of 11 nm. The MIC for each PA strain was 15.6 µg/ml, while the MBC was 31.25 µg/ml. All PA strains exposed to Ag NPs at sub-inhibitory concentrations (0.22-7.5 µg/ml) showed significant inhibitory effects on growth and biofilm formation. Biomass and biofilm metabolism were reduced dependent on Ag NP concentration. The expression of the quorum-sensing genes of all strains were significantly reduced at an Ag NP concentration of 7.5 µg/ml. The results demonstrate the extensive in-vitro antibacterial and antibiofilm performance of Ag NPs and their potential in the treatment of PA infection. It is recommended that future studies examine the possible synergy between Ag NPs and antibiotics.

Evaluation of the Effect Coronavirus Lockdown had on Chronic Disease Management Care in Pediatrics: A Survey of Jordanian Pediatricians.

The outbreak of the COVID-19 pandemic puts a great strain on the healthcare system, as the national and global infection rates increased rapidly. Efforts were devoted to minimizing the effects of the spreading pandemic without overwhelming the already stretched healthcare system. The study objective was to establish how coronavirus lockdown was affecting chronic disease care among pediatric patients admitted to hospitals in developing countries. For that purpose, a cross-sectional survey of registered pediatricians was carried out. Findings showed that the mortality rate from COVID-19 in children seemed to be low. However, children with chronic illnesses were likely to be gravely affected by the disturbance of repetitive healthcare services. About 79% of pediatricians treated a child with a chronic condition during the lockdown. Furthermore, 15% of patients with chronic diseases visiting pediatricians exhibited uncontrolled emerging complications. In addition, 9% of pediatricians reported one to five fatalities among children under their care due to delay or lack of appropriate medical care in the period of the lockdown. Residents (48.9%) reported a significantly (p < 0.001) higher proportion of providing face-to-face services compared with consultants (17.9%) and specialists (13.6%). In conclusion, the care of chronically ill children should be taken into consideration when implementing lockdown and/or social distancing, thus minimizing the negative effects of lockdown and/or social distancing on children with chronic diseases.

Clinical, Laboratory, and Imaging Features of COVID-19 in a Cohort of Patients: Cross-Sectional Comparative Study.

BACKGROUND: The clinical, laboratory, and imaging features of COVID-19 disease are variable. Multiple factors can affect the disease progression and outcome. OBJECTIVE: This study aimed to analyze the clinical, laboratory, and imaging features of COVID-19 in Jordan. METHODS: Clinical, laboratory, and imaging data were collected for 557 confirmed COVID-19 patients admitted to Prince Hamzah Hospital (PHH), Jordan. Analysis was performed using appropriate statistical tests with SPSS version 24. RESULTS: Of the 557 COVID-19 polymerase chain reaction (PCR)-positive cases admitted to PHH, the mean age was 34.4 years (SD 18.95 years; range 5 weeks to 87 years), 86.0% (479/557) were male, 41% (29/70) were blood group A+, and 57.1% (93/163) were overweight or obese. Significant past medical history was documented in 25.9% (144/557), significant surgical history in 12.6% (70/557), current smoking in 14.9% (83/557), and pregnancy in 0.5% (3/557). The mean duration of hospitalization was 16.4 (SD 9.3; range 5 to 70) days; 52.6% (293/557) were asymptomatic, and 12.9% (72/557) had more than 5 symptoms, with generalized malaise and dry cough the most common symptoms. Only 2.5% (14/557) had a respiratory rate over 25 breaths/minute, and 1.8% (10/557) had an oxygen saturation below 85%. Laboratory investigations showed a wide range of abnormalities, with lymphocytosis and elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer the most common abnormalities. Ground glass opacity was the most common imaging finding. Men had a significantly higher frequency of symptoms, incidence of smoking, reduced hemoglobin, increased monocyte %, elevated creatinine levels, and intensive care unit admissions compared with women (P<.05). Hospitalization duration was associated with increased age, male gender, symptom score, history of smoking, elevated systolic blood pressure, elevated respiratory rate, and elevated monocyte %, CRP, ESR, creatinine, and D-dimer (P<.05). CONCLUSIONS: Most COVID-19 cases admitted to PHH were asymptomatic. Variabilities in symptoms, signs, laboratory results, and imaging findings should be noted. Increased age, male gender, smoking history, and elevated inflammatory markers were significantly associated with longer duration of hospitalization.

A prediction model of risk factors for complications among SARS-CoV2 positive patients: Cases from Jordan.

BACKGROUND: The number of COVID-19 infected patients has been soaring in the Middle East countries. The disease poses a significant threat, decisions about prioritizing care should be made in accordance with the proven risk factors for complications. OBJECTIVE: The present study provides the first bespoke prediction model in the Middle East to identify COVID-19 patients, who are at higher risk for complications. METHOD: A case-control study design was adopted to compare the characteristics of successfully recovered patients with those who had complications. Complications were defined as admission to the intensive care unit, mechanical ventilation, sepsis or septic shock, pneumonia or respiratory failure, and death. The prediction model was created through multivariable logistic regression. Overall statistical significance tests for the model were carried out. RESULTS: All COVID-19 infected hospitalized patients (n = 133) in Amman - Jordan were included in the study. Successfully recovered were 125 patients. The median age (IRQ) was 26 (10-40). Almost 30% were >40 years. Patients with complications were eight patients, age 63 (51.5-71.5). The prediction model identified the following variables as risk factors: diabetes (OR = 59.7; 95% CI: 3.5-1011.5, p = 0.005), fever (OR = 24.8; 95% CI: 1.4-447.3, p = 0.029), SHORTNESS OF BREATH (OR = 15.9; 95% CI: 1.3-189.7, p = 0.029), body mass index (OR = 0.74; 95% CI: 0.61-0.88, p = 0.001), abnormal Neutrophils (OR = 16.8; 95% CI: 1.0-292.0, p = 0.053). Prediction model was statistically significant, χ2(5) = 86.1, p < 0.0005. CONCLUSIONS: Unlike reports from China, the most influential variables that led to disease progression in Jordanian patients were diabetes, fever, shortness of breath, body mass index, and abnormal neutrophils. Similar to reports from the USA, smoking was not a leading factor for complications. Comorbidities and patient health status, rather than age, were the primary risk factors for complications. Treatment with Hydroxychloroquine showed no protective effect.

Family readiness for evidence-based injury prevention and car seat safety in Jordan.

Primary prevention involves developing positive health behaviours designed to avert adverse health outcomes, whereas evidence-based primary prevention adopts practices that reduce illness and injury. This study's objective was to determine whether families in Jordan would adopt car safety measures after participating in an evidence-based injury prevention programme. Parents of children attending a regional government hospital in Jordan took part in an evidence-based educational class on child car restraints and car safety, six months later follow-up phone calls were made to see if the parents implemented the knowledge obtained in the class. Fifty families participated in the injury prevention class. The results showed that the evidence-based class on child restraint systems led to the adoption of the three interventions by the parents. At the time of the class 45% of parents allowed their infants to sit in the front seat, in the lap of an adult, this was reduced to 12%, being a 33% reduction. In addition, for children aged 6-12 using a seat belt in the back seat, the parents reported that their children using a seat belt increased from 13% to 70%. Finally, parents who participated were more likely to use a child car seat.

Clinical and laboratory characteristics of SARS-CoV2-infected paediatric patients in Jordan: serial RT-PCR testing until discharge.

BACKGROUND: Data on COVID-19 in children are limited. This study aimed to identify the clinical characteristics, laboratory results and longitudinal RT-PCR- testing pattern in children infected with theSARS-CoV2 virus and admitted to a hospital in Jordan. METHODS: The study is a retrospective chart review of patients admitted between 16 March and 23 April 2020. All infected children in Jordan were hospitalised. Serial RT-PCR testing was undertaken 7 days after the first test and then on alternate days until discharge. The association between patient symptoms and laboratory results and whether there was a statistically significant median difference in the number of days until negative RT-PCR results between patients was studied. RESULTS: Sixty-one patients with positive SARS-CoV2 swabs were admitted, 34 (55.7%) of whom were symptomatic. The most common symptom was nasal congestion (21/61, 34.3%), followed by generalised malaise and headache (12/6, 19.7%). A rash was detected in 5/61 (8.2%) of them. Fifty-five patients (90.1%) underwent investigations: 4 (7.4%) of them had lymphopenia, 4 (7.4%) had eosinopenia, 8 (14.5%) had eosinophilia, and platelets were elevated in 5 (9.1%) children. CRP was measured in 33/61 (54.1%) patients and all were normal. ESR levels were available for 11/61 (18%) patients and were elevated in 5 (45.5%). There was a statistically significant association between laboratory results and symptom expression (p = 0.011). The longest time until the first negative RT-PCR result was 39 days. CONCLUSION: All children admitted who tested positive for SARS-CoV2 had mild symptoms and five had cutaneous manifestations. RT-PCR may remain positive for over one month.

Respiratory syncytial virus causes increased bronchial epithelial permeability.

BACKGROUND: Respiratory syncytial virus (RSV)-induced diseases are mediated through active cytokines released during infection. We hypothesized that RSV infection causes bronchial epithelial monolayer permeability in vitro via induction of vascular endothelial growth factor (VEGF). METHODS: Human bronchial epithelial cells were infected with RSV. In some cultures, VEGF antibody was included to block VEGF response; in other cultures, palivizumab was added to block RSV infection. Permeability was assessed in real-time using electric cell-substrate impedance sensing. VEGF release was assessed using enzyme-linked immunosorbent assay. Gap formation was assessed using live cell imaging. RESULTS: RSV-infected cells demonstrated a decrease in the resistance of the monolayer indicating an increase in permeability; this increase was blocked with VEGF-specific antibody, and palivizumab. Intercellular gap formation developed in RSV-infected epithelial monolayers. CONCLUSION: RSV increases permeability of the bronchial airway epithelial monolayer via VEGF induction.

RSV causes HIF-1alpha stabilization via NO release in primary bronchial epithelial cells.

RSV infection is characterized by airway edema. Stabilization of hypoxia inducible factor-1alpha (HIF-1alpha) is important in both inflammation and edema formation. In this study we evaluated whether RSV induced release of nitric oxide (NO) by bronchial airway epithelial cells leading to the stabilization of HIF-1alpha and subsequent transcription of VEGF(165). Primary human bronchial epithelial cells (HBEpC) were used; cell supernatants were analyzed. Western blot analysis was used for the detection of HIF-1alpha. Bronchial airway epithelial monolayer permeability was assessed using electric cell-substrate impedance sensing (ECIS) in real time. There was increased stabilization of HIF-1alpha in RSV infected cells. Addition of an NO inhibitor blocked RSV mediated HIF-1alpha expression. Antagonism of NO also inhibited VEGF production and HBEpC monolayer permeability. Our results demonstrate that in HBEpC, RSV induced NO causes stabilization of HIF-1alpha in vitro.