Glycemic Control in an Undiagnosed Diabetes Mellitus Patient with Coronavirus Disease 2019

Diabetes mellitus in coronavirus disease 2019 (COVID‑19) patients is associated with poor outcomes due to poorly understood reasons inclusive of blood sugar patterns. Hence, we report a case of a 52‑year‑old Nigerian man known hypertensive heart disease patient, previously undiagnosed diabetes mellitus patient with difficulty in blood sugar control, heart failure, and persistent severe acute respiratory syndrome coronavirus 2 8 weeks after he tested positive. A 52‑year‑old male civil servant obese, known hypertensive heart disease patient presented with complaints of fever, cough, difficulty with breathing, headache, and generalized body weakness. At presentation, he had respiratory distress with low oxygen saturation of 78% and hyperglycemia (blood sugar of 40 mmol/l). His body mass index was 35.9 kg/m2 . Chest radiography showed ground‑glass appearance with cardiomegaly. Over the next 10 days on  admission, his blood sugar fluctuated between hyperglycemia and an episode of hypoglycemia with occasional euglycemia and had glycated hemoglobin of 10.8%. The full blood count was normal, electrolyte, urea and creatinine showed mild elevation of the urea and creatinine, other parameters were normal, while the lipid profile showed hypercholesterolemia. He received multiple doses of insulin, anti‑hypertensive, lopinavir/ ritonavir, methylprednisolone, and azithromycin. The patient was weaned off oxygen after 10 days and discharged home 15 days after admission. This case report highlighted the challenges that may face a patient with undiagnosed diabetes mellitus and COVID‑19. It also brings forth the need to expand research options in COVID‑19 and risk factors associated with the disease as the world strives to control the global pandemic. Keywords: Coronavirus disease 2019, glycemic control, undiagnosed diabetes mellitu

Potential of sewage irrigation for heavy metal contamination in soil–wheat grain system: ecological risk and environmental fate

Anthropogenic activities are major cause of environmental pollution with significant risks for human health that can lead to excessive pollutant entry into the terrestrial ecosystem. The present study was conducted to evaluate the impact of bioaccumulation of carcinogenic metals (Cd, Ni, Co, Cr), and mineral elements (Zn, Fe, Mn and Cu) in the wheat irrigated with sewage water and different environmental traits (bio-concentration factor, pollution load index, daily intake of metals, health risk index) were compared to understand the ultimate sink of these toxic metals. The Cd was in range of 2.89–3.04 mg/kg in soil. The Fe and Mn were in range of 2.87–4.16 and 1.54–1.66 mg/kg, while Zn varies from 0.18 to 1.21 mg/kg, respectively. Grain exhibit higher concentration (3.31 mg/kg) of Zn while lowest (1.02 mg/kg) of Ni. Bio-concentration factor (BCF) values of Cd, Ni, Fe and Mn being less than 1.0 indicates lower Ni, Cd, Fe and Mn concentration in grains. BCF varies from 0.46 to 0.80 mg/kg for Cd, 0.31 to 0.41 mg/kg for Ni, 0.29 to 0.44 mg/kg for Fe and 0.15 to 0.73 mg/kg for Mn. Pollution load index (PLI) of Zn and Cd was lowest and highest among the evaluated trace metals, respectively. Health risk index was highest for Zn and Cd while it was < 1 for all other metals that showed no danger to human health. Enrichment factor (EF) of Zn was highest followed by Cd while found lowest in Mn. To minimize the health risks in humans, regular monitoring of wheat crop irrigated with wastewater is highly recommended.Universidade de Vigo/CISU

Resistance profiles and biofilm formation of coagulase negative staphylococci isolated from clinical specimens in a tertiary care hospital in Palestine: Resistance profiles and biofilm formation of CoNS from Palestine

Background: Coagulase-negative staphylococci (CoNS) represent one of the major resistant nosocomial pathogens where its biofilm-related infections often fail to respond to antibiotic chemotherapy. Here, we studied the resistance profiles and biofilm formation in CoNS isolates from clinical specimens at Al Shifa hospital in Gaza, Palestine. Methods: This study was carried out from March to July 2016 and included 81 clinical isolates. Identification and antibiotic susceptibility testing were performed using VITEK-2 system. The presence of nuc and mecA genes was performed using multiplex PCR. Qualitative and quantitative biofilm assays were performed using standard methods. Results: Of the 81 clinical CoNS isolates, S. haemolyticus was the most common species (34, 42%), followed by S. epidermidis (26, 32.1%) and S. saprophyticus (13, 16%). The majority of isolates (83.9%) were from surgery, ICUs, pediatrics and medicine wards and the most common source was pus (28, 34.6%). Antibiotic resistance was highest against aminoglycosides, β-lactams, carbapenems, cephalosporins, fluoroquinolones, fosfomycin and macrolides. Though, no resistance was detected against rifampicin, vancomycin, teicoplanin, nitrofurantoin, linezolid and mupirocin. The antibiotic resistance among MR-CoNS was significantly higher than that among MS-CoNS. Nearly 88.9% of isolates were multidrug resistant with higher percentage among MR-CoNS. Most S. epidermidis (76.9%) isolates were biofilm producer, with statistically significant association between methicillin resistance and biofilm production. Conclusions: High rates of antibiotic resistance were found among CoNS to commonly used antibiotics and the majority were methicillin and multidrug resistance. Most S. epidermidis isolates were biofilm producer. These results justified the necessity for national programs and measures to monitor and manage the usage of antibiotics in the Palestinian hospitals and community

Effectiveness of interactive teaching intervention on medical students' knowledge and attitudes toward stem cells, their therapeutic uses, and potential research applications

Background: Stem cell science is rapidly developing with the potential to alleviate many non-treatable diseases. Medical students, as future physicians, should be equipped with the proper knowledge and attitude regarding this hopeful field. Interactive teaching, whereby the teachers actively involve the students in the learning process, is a promising approach to improve their interest, knowledge, and team spirit. This study aims to evaluate the effectiveness of an interactive teaching intervention on medical students' knowledge and attitudes about stem cell research and therapy. Methods: A pre-post test study design was employed. A six-session interactive teaching course was conducted for a duration of six weeks as an intervention. Pre- and post-intervention surveys were used. The differences in the mean scores of students' knowledge and attitudes were examined using paired t-test, while gender differences were examined using an independent t-test. Results: Out of 71 sixth-year medical students from different nationalities invited to participate in this study, the interactive teaching course was initiated by 58 students resulting in a participation rate of 81.7%. Out of 58 students, 48 (82.8%) completed the entire course. The mean age (standard deviation) of students was 24 (1.2) years, and 32 (66.7%) were males. The results showed poor knowledge about stem cells among the medical students in the pre-intervention phase. Total scores of stem cell-related knowledge and attitudes significantly improved post-intervention. Gender differences in knowledge and attitudes scores were not statistically significant post-intervention. Conclusions: Integrating stem cell science into medical curricula coupled with interactive learning approaches effectively increased students' knowledge about recent advances in stem cell research and therapy and improved attitudes toward stem cell research and applications. Keywords: Arab; Attitudes; Education; Interactive teaching; Jordan; Knowledge; Medical curriculum; Stem cells; Students

Epidemiology of COVID-19 and Predictors of Outcome in Nigeria: A Single-Center Study.

There is a paucity of information regarding the epidemiology and outcome of COVID-19 from low/middle-income countries, including from Nigeria. This single-center study described the clinical features, laboratory findings, and predictors of in-hospital mortality of COVID-19 patients. Patients admitted between April 10, 2020 and June 10, 2020 were included. Forty-five patients with a mean age of 43 (16) years, predominantly male (87%), presented with fever (38%), cough (29%), or dyspnea (24%). In-hospital mortality was 16%. The independent predictors of mortality were hypoxemia (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.3-5.1) and creatinine \u3e 1.5 mg/dL (aOR: 4.3; 95% CI: 1.9-9.8)

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London