BACTERIAL CAUSES AND ANTIMICROBIAL SENSITIVITY PATTERN OF EXTERNAL OCULAR INFECTIONS IN SELECTED OPHTHALMOLOGY CLINICS IN SANA’A CITY

Objectives: The aim of the current study was to reveal the bacterial profile and pattern of sensitivity to antibiotics for external ocular infections for patients who attended selected ophthalmology clinics in the city of Sana’a. Methods: A cross-sectional study design was used from September 2016 to October 2017 where a total of 197 patients with infection of external eye were included in the study which included conjunctivitis, keratitis, blepharitis and Blepharoconjunctivitis. Samples were collected and transferred to the National Center of Public Laboratories (NCPHL), in Sana'a. Possible bacterial pathogens have been isolated and identified using regular laboratory techniques, and microbial sensitivity testing has been carried out using a disc diffusion method. Results: A total of 197 ocular samples were obtained for microbiological evaluation, of these 146 (74.1%) have bacterial growth. Bacteria of Gram positive accounted for 52.1% and the prevalent isolation was S. aureus (30.1%). Gram negative bacteria made up 47.9% and the predominant isolation was Pseudomonas aeruginosa (26.7%). The majority of Gram-positive bacteria were sensitive to ciprofloxacin (90% - 100%), vancomycin (86% - 100%) and Gram-negative isolates sensitive for amikacin (100%) and ciprofloxacin (63% - 100%). Conclusion: These results revealed that Gram-positive bacteria were the generally common bacteria isolated from infections of external eye and were more susceptible to vancomycin and ciprofloxacin while Gram-negative isolates were more susceptible to ciprofloxacin and amikacin.  The high rate of resistance for most antibiotics in Yemen, leaves ophthalmologists with very few options of drugs to treat eye infections. Large-scale ongoing studies in the future should also be conducted in order to monitor the antimicrobial resistance of the external ocular bacterial isolates.                                   Peer Review History: Received 20 May 2020; Revised 25 June; Accepted 4 July, Available online 15 July 2020   Academic Editor: Dr. Asia Selman Abdullah, Al-Razi university, Department of Pharmacy, Yemen, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewer(s) detail: Dr. Jucimary Vieira dos Santos, Hemonorte Dalton Barbosa Cunha, Brazil, [email protected] Dr. Sabah Hussien El-Ghaiesh, Tanta University, Egypt, [email protected]  Similar Articles: EPIDEMIOLOGY, BACTERIAL PROFILE, AND ANTIBIOTIC SENSITIVITY OF LOWER RESPIRATORY TRACT INFECTIONS IN SANA’A AND DHAMAR CITY, YEME

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Solution of Second- and Higher-Order Nonlinear Two-Point Boundary-Value Problems Using Double Decomposition Method

The present paper makes use of the efficient double decomposition method to propose a method for solving two-point boundary-value problems, featuring second- and higher-order nonlinear ordinary differential equations. The efficacy of the proposed method is demonstrated on numerous test problems. In the end, a high level of exactitude between the obtained approximate solution and the available exact solution is achieved

Immunological and Molecular Study of Interleukin17A and Uropathogenic E. coli among Patients in Holy Karbala, Iraq

The current study amid to investigate association of Interleukin-17A with uropathogenic Escherichia coli among patients with urinary tract infection in karbala province, Iraq. Bacterial infections are widespread in urinary tract infections with a global extention. Uropathogenic E.coli (UPEC) is the most common causes of these infections. Out of 110 patients were examined by urologists for urinary tract infection, 25 patients showed positive result for UPEC and other 25 showed positive result for other bacterial pathogens. UPEC were diagnosed depended on the cultural, microscopical, biochemical examinations and confirm the identification by using Vitek2 system. Polymerase chain reaction was used to detection of four genes (pap C, cnfA, fim H, and fyu A). Interleukin-17A concentration in urine was measured by using ELISA kit. out of 110 urine samples, 56 (44.90%) with significant bacteriuria, 44(40%) with non-significant bacteriuria and 10 (9.09 %) with negative culture. The presence of UPEC among significant bacteriuria was 25/56 (44.64 %). The distribution of pap C, cnfA, fim H, and fyu A genes among UPEC were 17(68%), 17(68%), 16(64%) and 15(60%) respectively. Through UTI patients, 50 gave positive (121.70) pg/ml results compared to 30 of control (13. 94) pg/ml. Among uropathogenic Escherichia coli patients, 25 gave positive (92.80) pg/ml results, while 25 of other bacterial pathogens gave positive (15.40) pg/ml results

Weakly supervised skin lesion segmentation based on spot‐seeds guided optimal regions

Abstract Automatic skin lesion segmentation is the most critical and relevant task in computer‐aided skin cancer diagnosis. Methods based on convolutional neural networks (CNNs) are mainly used in current skin lesion segmentation. The requirement of huge pixel‐level labels is a significant obstacle to achieve semantic segmentation of skin lesion by CNNs. In this paper, a novel weakly supervised framework for skin lesion segmentation is presented, which generates high‐quality pixel‐level annotations and optimizes the segmentation network. A hierarchical image segmentation algorithm can predict a boundary map for training images. Then, the optimal regions of candidate hierarchical levels are selected. Afterward, Superpixels‐CRF built on the optimal regions is guided by spot seeds to propagate information from spot seeds to unlabeled regions, resulting in high‐quality pixel‐level annotations. Using these high‐quality pixel‐level annotations, a segmentation network can be trained and segmentation masks can be predicted. To iteratively optimize the segmentation network, the predicted segmentation masks are refined and the segmentation network are retrained. Comparative experiments demonstrate that the proposed segmentation framework reduces the gap between weakly and fully supervised skin lesion segmentation methods, and achieves state‐of‐the‐art performance while reducing human labeling efforts

Nasal Carriage and Methicillin Resistance of Staphylococcus aureus among Schoolchildren in Sana’a City, Yemen

Background. Staphylococcus aureus (S. aureus) is a frequent cause of serious health problems with high morbidity and mortality. The risk of S. aureus infections is increased with the emergence of methicillin-resistant S. aureus (MRSA). This study aims to determine the nasal carriage rate of both S. aureus and MRSA among schoolchildren in Sana’a city. Methods. This is a cross-sectional study conducted from January 2018 to May 2020. Five hundred and thirty-six students were enrolled. Their age ranged from 5 to 19 years with the mean age and standard deviation equal to 13.3 ± 3.5 years. Nasal swabs were collected from each student for culturing and methicillin susceptibility testing. Results. Students with positive culture were 271 (51%) males and 265 (49%) females. S. aureus was isolated from 129 (24%) students whereas the overall prevalence of MRSA was 8 (1.5%). S. aureus was significantly recovered from students at the age group of 10–14 years (χ2 = 7.02; p=0.03), females than males (OR = 1.96; χ2 = 10.75; p=0.001), and students who were admitted into hospitals (OR = 1.6; χ2 = 4.89; p=0.03). Nevertheless, there were no significant differences between MRSA carriage and students’ age (χ2 = 2.3; p=0.32), gender (OR = 1.02; χ2 = 0.001; p=0.63), and hospital admission (OR = 1.4; χ2 = 0.25; p=0.62). Conclusions. The prevalence of MRSA is low among schoolchildren in Sana’a city. Age, gender, and previous hospital admission were statistically associated with nasal carriage of S. aureus but not MRSA nasal carriage