Empiric Antibiotic Therapy in the Treatment of Community-acquired Pneumonia in a General Hospital in Saudi Arabia

Background: Guideline-based empiric antimicrobial therapy is recommended for the treatment of community-acquired pneumonia (CAP). In this study, we evaluate the pattern of empiric antibiotics of CAP patients. Materials and Methods: Patients with CAP were retrieved from the health information unit using the International Classification of Diseases, Ninth Revision. The electronic pharmacy database was used to retrieve prescribed antibiotics and the duration of therapy for each antibiotic. Results: A total of 1672 adult patients were included in the study and 868 (52%) were male. Of all the patients, 47 (2.8%) were admitted to the intensive care unit (ICU). The most frequently used antibiotics were levofloxacin (68.12%), ceftriaxone (37.7%), imipenem-cilastatin (32.5%), and azithromycin (20.6%). The mean days of therapy of each of these antibiotics were 3.2, 2.8, 4.4, and 2.9, respectively. A combination therapy of levofloxacin and imipenem-cilastatin was prescribed for 355 (21.8%) of non-ICU patients versus 20 (60.6%) of ICU patients (P = 0.0007). Imipenem-cilastatin was prescribed for 518 (31.8%) of non-ICU patients versus 25 (56.8%) of ICU patients (P = 0.0009). Levofloxacin was prescribed for 1106 (68%) of non-ICU patients versus 33 (75%) of ICU patients (P = 0.412). Ceftriaxone use decreased significantly from 40.9% in 2013 to 25.9% in 2016 (P = 0.034). In addition, levofloxacin use increased from 63.7% to 75% (P = 0.63). Conclusion: The most commonly used antibiotics were levofloxacin, ceftriaxone, imipenem-cilastatin, and azithromycin. The data call for further refinement and prospective audit of antibiotic use in CAP, especially in non-ICU settings

Thermal Effects for Shaft-Pre-Stress on Rotor Dynamic System

This Paper outlines study behaviour of rotating shaft with high speed under thermal effects. The method of obtaining the frequency response functions of a rotor system with study whirl effect in this revision the raw data obtained from the experimental results (using Smart Office program) are curve-fitted by theoretical data regenerated from some of the experimental data and simulating it using finite element (ANSYS 12). (FE) models using the Eigen analysis capability were used to simulate the vibration. The results were compared with experimental data show analysis data with acceptable accuracy and performance. The rotating effect causes un-symmetry in the system matrices, resulting in complexity in decoupling the mathematical models of the system for the purpose of modal analysis. Different method is therefore required, which can handle general system matrices rather than symmetrical matrices, which is normal for passive structures. Mathematical model of the system from the test data can be assembled. The frequency response functions are extracted, Campbell diagram are draw and simulated. (FE) is used to carry out such as simulation since it has good capability for Eigen analysis and also good graphical facility. Keywords: Thermal effects, Modelling, Campbell diagram, Whirl, Rotor dynamics.Comment: Published by: Academic Research Publishing Agency. All rights reserved, 6 pages, 4 figures, 1 pictur

A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Background The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first described in 2012 and attracted a great international attention due to multiple healthcare associated outbreaks. The disease carries a high case fatality rate of 34.5%, and there is no internationally or nationally recommended therapy. Method We searched MEDLINE, Science Direct, Embase and Scopus databases for relevant papers published till March 2019 describing in vitro, in vivo or human therapy of MERS. Results Initial search identified 62 articles: 52 articles were from Medline, 6 from Embase, and 4 from Science Direct. Based on the inclusions and exclusions criteria, 30 articles were included in the final review and comprised: 22 in vitro studies, 8 studies utilizing animal models, 13 studies in humans, and one study included both in vitro and animal model. There are a few promising therapeutic agents on the horizon. The combination of lopinavir/ritonavir and interferon-beta- 1b showed excellent results in common marmosets and currently is in a randomized control trial. Ribavirin and interferon were the most widely used combination and experience comes from a number of observational studies. Although, the data are heterogenous, this combination might be of potential benefit and deserve further investigation. There were no randomized clinical trials to recommend specific therapy for the treatment of MERS-CoV infection. Only one such study is planned for randomization and is pending completion. The study is based on a combination of lopinavir/ritonavir and interferon-beta- 1b. A fully human polyclonal IgG antibody (SAB-301) was safe and well tolerated in healthy individuals and this agent may deserve further testing for efficacy. Conclusion Despite multiple studies in humans there is no consensus on the optimal therapy for MERS-CoV. Randomized clinical trials are needed and potential therapies should be evaluated only in such clinical trials. In order to further enhance the therapeutic aroma for MERS-CoV infection, repurposing old drugs against MERS-CoV is an interesting strategy and deserves further consideration and use in clinical settings

Modeling and Designing of a Novel Lab-scale Passive Solar Still

The solar still is an emerging water distillation technology gaining popularity among the scientific community. Achieving a high throughput and/or performance in solar stills remains an unresolved challenge. In this study, the feasibility of utilizing solar distillation systems for large water production was investigated. A solar still was designed and tested with different brackish waters under solar insolation in Los Angeles from March to April. The inner surface area of the cell was about 12.7 cm  12.7 cm with a maximum volume of 322.6 cm3. The still performance was evaluated experimentally and modeled theoretically, showing a good agreement between theory and experiment. The maximum achieved efficiency was 20.54%, corresponding to a freshwater production of 384.4 mL/day·m2 (6.2 mL/day). Lowering the feed amounts from 120 to 30 mL/day resulted in increasing the experimental performance from 6% to 18.3% due to the quick ramp in heat of vaporization; however, the production rates decreased from 446.4 to 341 mL/day·m2 (7.2 to 5.5 mL/day). Polystyrene insulation and a blackened walls/basin can improve the performance by maintaining high temperature, decreasing heat loss, and enhancing solar absorption. It is concluded that still materials, insolation rate, and inclination angle are the most critical design factors

Case series of unusual causes intestinal obstruction in infants and children

Introduction Many of the causes of intestinal obstruction arise from congenital anomalies that can present at any time from infancy to adulthood. Other frequent causes of intestinal obstruction in pediatric population results from complicated external hernias, intussusceptions, volvulus, or bands of adhesions.Patients and methods We report seven unusual cases presented with symptoms and signs of acute intestinal obstruction in infants and children, which necessitated surgical intervention. Radiological investigation showed signs of intestinal obstruction.Results On exploration, rare causes of intestinal obstruction were found. In the first patient, congenital mesenteric defect was the cause of obstruction. The second patient had unusual entrapment of a loop of bowel in the ileocecal recess. In the third patient, non-Hodgkin’s lymphoma was the leading point for intussesception. In the fourth patient, a large multiloculated chylolymphatic cyst was found. In the fifth, sixth, and seventh patients, a rare presentation of remnants of ophalomesentric duct was identified. In the eighth patient, a large polyp of Peutz–Jeghers syndrome was found to obstruct the lumen of the jejunum, and it was the nidus for jejunojejunal intussesception. All of the previously mentioned causes of obstruction are rarely observed in children.Conclusion Management of these conditions requires ahigh degree of suspicion, careful assessment, and  awareness while the appropriate treatment needs to be tailored to the individual situation.Keywords: childhood period, intestinal obstruction, unusual  presentation