High Genetic Diversity of Human Rhinovirus among Pilgrims with Acute Respiratory Tract Infections during 2019 Hajj Pilgrimage Season

OBJECTIVES: Acute Respiratory tract infections (ARI) due to Human Rhinoviruses (HRV) are common in pilgrims during the annual Hajj pilgrimage. The objective of this study was to investigate the genetic diversity of HRV among pilgrims with respiratory symptoms during Hajj 2019. METHODS: HRV infection was detected using multiplex real time RT-PCR. Cycle sequencing was performed on positive samples and the sequences were subjected to phylogenetic analysis. RESULTS: 19 HRV-positive respiratory samples were sequenced. All three serotypes of HRV were identified: HRV-A (13; [68.42%)) was more common than HRV-B (2; [10.53%]), and HRV-C (4; [21.05%]). HRV-A species were found to be of genotypes A101, A21, A30, A57, A23, A60 and A11. HRV-B species belonged to genotypes B4 and B84, and HRV-C species were of genotypes C15, C3 and C56. CONCLUSIONS: Sequencing studies of respiratory tract viruses in pilgrims are important. We provide preliminary evidence of high diversity of HRV genotypes circulating in pilgrims in a restricted area during Hajj. This requires further clinical and sequencing studies of viral pathogens in larger consorts of overseas and local pilgrims

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Malignant pleural effusion biomarkers as predictor for chemical pleurodesis success

AbstractBackground42–77% of exudative pleural effusions are due to malignant diseases (Marel et al., 1993) [1]. This study aimed to evaluate the value of biochemical parameters of the pleural aspirate in predicting success of chemical pleurodesis in adult patients with malignant pleural effusion.Patients and methodsThis prospective study included 30 adult patients with malignant pleural effusion diagnosed by clinical examination, Chest CT scanning and closed pleurocentesis. Patient ages were mean of 60.4±7.8years, multiple sessions of closed pleurocentesis were carried out followed by insertion of an intercostal tube. The pleural aspirate was then sent for chemical analysis to detect Glucose, pH, and LDH. Pleurodesis was then done either by using Tetracycline (group A), or Bleomycin (group B). All patients were then followed up for success of the pleurodesis process within one month.ResultsWithin one month of follow-up, rates of clinical response to treatment in group A (Tetracycline) were successful in 40%; versus group B (73.3%). Complete response (CR) occurred in group A cases (20%); versus 33.3% in group B; whereas partial response (PR) occurred in 3 cases of group A; versus 6 cases of group B; and treatment failure (TF) occurred in 9 of group A cases versus 4 of group B cases. None of our patients died. Morbidity occurred in the form of mild-to-moderate.The success of the pleurodesis was closely-associated with higher glucose and pH levels together with a low LDH level in the pleural fluid.ConclusionThe success of pleurodesis is usually higher when the pleural fluid pH and glucose levels are high & the LDH level is low in MPE