Role of fiberoptic bronchoscopy and BAL in assessment of the patients with non-responding pneumonia

Background: Non-responding pneumonia is usually a topic of interest for pulmonologists. Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) may be an important tool in assessment of non-responding pneumonia. There is paucity of recent studies in this area. Aim: This study aimed to assess the impact of early bronchoscopy and BAL in etiological diagnosis of the patients with non-responding pneumonia with special emphasis on efficacy of FOB and BAL in diagnosis. Settings and design: A prospective, observational study was conducted in chest and medical microbiology and immunology departments, Zagazig University Hospitals. Patients and methods: There were total 135 patients included in our study after fulfilling the criteria of non-responding pneumonia by clinical and laboratory parameters, patients were subjected to FOB and BALF microbiological, cytological, histopathological investigations. Results: The patients were 90 males and 45 females with a mean age of 47.6 ± 12.2 years. Unilateral lung involvement was seen in 108 (80%) patients, whereas bilateral involvement in 27 (20%) patients. Right upper lobe was the most commonly involved site (25.9%). In this study, bacterial pneumonia 83.71% was found to be the commonest etiology of non-resolving pneumonia, followed by bronchogenic carcinoma 13.3% and tuberculosis 2.96%. FOB was done for all patients. BAL fluid results were 88 positive, gram stain samples (65.1%), 4 BAL ZN stain and mycobacterial culture positive cases (2.96%), pyogenic organisms were isolated in 113 patients 83.71% by BAL fluid culture. Bronchoscopic biopsies were also performed in 18 cases. BAL fluid cytology was positive in 6 cases (33.3%), transbronchial forceps biopsy positive results were found in 10 cases (55.55%) and bronchial brushing showed positive results in 3 cases (16.66%). Conclusions: NRP is common and represents a difficult clinical problem as the cause may vary from a benign delay in recovery to life-threatening progressive pneumonia. A systematic approach to investigation and management is recommended with consideration of both infectious and non-infectious causes

Willingness to Receive COVID-19 Vaccination among Older Adults in Saudi Arabia: A Community-Based Survey

Identifying the factors driving vaccine hesitancy can improve vaccine attitudes and motivate individuals to have the recommended vaccinations. However, failure to address the issue directly, or worse, ignoring it, could deepen such concerns, resulting in lower vaccination rates, leading to elevated rates of illness and vaccine-preventable deaths among older adults. The aim of this study was to explore the rate of acceptance of the COVID-19 vaccine among older adults in Saudi Arabia, along with the associated predicting factors and reasons for hesitancy. This study extracted data from a cross-sectional online survey on the acceptability of COVID-19 vaccination in Saudi Arabia, which was conducted from 8 to 14 December 2020. The sample of the study included 488 older adults aged 50 and older. The major data analytic tools employed in the study were bivariate and multivariable regression analyses. Among the 488 participants, 214 (43.85%) reported willingness to accept the COVID-19 vaccine when available. Older men were more likely to be willing to be vaccinated (adjusted odds ratio (aOR): 2.277; 95% confidence interval (CI): 1.092–4.745) than older women. High levels of education were significantly associated with willingness to be vaccinated. Older adults who had previously refused any vaccine were less likely to take the COVID-19 vaccine (aOR: 0.358; 95% CI: 0.154–0.830). Those who expressed a high or very high level of concern related to becoming infected were more likely to accept the vaccine against COVID-19 (aOR: 4.437; 95% CI: 2.148–9.168). Adverse side effects (27.01%), and safety and efficacy concerns (22.63%) were the most commonly cited reasons for vaccine hesitancy. The vaccination acceptance rate among older adults in Saudi Arabia is low. Interventions designed specifically for older adults addressing worries and concerns related to the vaccine are of paramount importance. In particular, these interventions should be tailored to address gender-based and health literacy level differences

Worldwide practices on flexible endoscope reprocessing

Abstract Background Endoscopy related infections represent an important threat for healthcare systems worldwide. Recent outbreaks of infections with multidrug resistant micro-organisms have highlighted the problems of contaminated endoscopes. Endoscopes at highest risk for contamination have intricate mechanisms, multiple internal channels and narrow lumens that are especially problematic to clean. In light of raised awareness about the necessity for meticulous reprocessing of all types of endoscopes, a call for international collaboration is needed. An overview is presented on current practices for endoscope reprocessing in facilities worldwide. Method An electronic survey was developed and disseminated by the International Society for Antimicrobials and Chemotherapy. The survey consisted of 50 questions aimed at assessing the reprocessing of flexible endoscopes internationally. It covered three core elements: stakeholder involvement, assessment of perceived risks, and reprocessing process. Results The survey received a total of 165 completed responses from 39 countries. It is evident that most facilities, 82% (n = 136), have a standard operating procedure. There is, however a lot of variation within the flexible endoscope reprocessing practices observed. The need for regular training and education of reprocessing practitioners were identified by 50% (n = 83) of the respondents as main concerns that need to be addressed in order to increase patient safety in endoscope reprocessing procedures. Conclusion This international survey on current flexible endoscope reprocessing identified a large variation for reprocessing practices among different health care facilities/countries. A standardised education and training programme with a competency assessment is essential to prevent reprocessing lapses and improve patient safety

Figure 3

<p>(Middle panel) Tukey-Kramer test results showing significant increases or decreases in gene expression between the groups identified in the PC-SOM analysis (p>0.05). Genes are ranked in order of significance from highest to lowest. Violin and bubble plots (above and below) show qualitative and quantitative changes (respectively) in per-cell gene expression for the genes with the greatest change between groups. Top panel shows genes whose level and probability of expression undergo an “activating” effect during reprogramming, while genes with decreased probability of expression during reprogramming are labeled “inactivating” and shown in the bottom panel.</p

Exploring the reported adverse effects of COVID-19 vaccines among vaccinated Arab populations: a multi-national survey study

Abstract The coronavirus disease 2019 (COVID-19) pandemic has been a major challenge worldwide for the past years with high morbidity and mortality rates. While vaccination was the cornerstone to control the pandemic and disease spread, concerns regarding safety and adverse events (AEs) have been raised lately. A cross-sectional study was conducted between January 1st and January 22nd, 2022, in six Arabic countries namely Saudi Arabia, Egypt, Syria, Libya, Iraq, and Algeria. We utilized a self-administered questionnaire validated in Arabic which encompassed two main parts. The first was regarding sociodemographic data while the second was about COVID-19 vaccination history, types, doses, and experienced AEs. A multistage sampling was employed in each country, involving the random selection of three governorates from each country, followed by the selection of one urban area and one rural area from each governorate. We included the responses of 1564 participants. The most common AEs after the first and second doses were local AEs (67.9% and 46.6%, respectively) followed by bone pain and myalgia (37.6% and 31.8%, respectively). After the third dose, the most common AEs were local AEs (45.7%) and fever (32.4%). Johnson and Johnson, Sputnik Light, and Moderna vaccines showed the highest frequency of AEs. Factors associated with AEs after the first dose included an increase in age (aOR of 61–75 years compared to the 12–18 years group: 2.60, 95% CI: 1.59–4.25, p = 0.001) and male gender (OR: 0.72, 95% CI: 0.63–0.82, p < 0.001). The cumulative post-vaccination COVID-19 disease was reported with Sinovac (16.1%), Sinopharm (15.8%), and Johnson and Johnson (14.9) vaccines. History of pre-vaccination SARS-CoV-2 infection significantly increases the risk of post-vaccination COVID-19 after the first, second, and booster doses (OR: 3.09, CI: 1.9–5.07, p < 0.0001; OR: 2.56, CI: 1.89–3.47, p < 0.0001; and OR: 2.94, CI: 1.6–5.39, p = 0.0005 respectively). In conclusion, AEs were common among our participants, especially local AEs. Further extensive studies are needed to generate more generalizable data regarding the safety of different vaccines