Frequency Of Bacterial Co-Infections Isolated from Covid-19 Positive Patients From Tertiary Care Hospital Of Karachi

Objective: This study aims to determine the frequency of bacterial co-infections in COVID-19-positive patients. Methodology: A prospective cross-sectional study was conducted in the Department of Microbiology, Pakistan, from November 15, 2021, to April 15, 2022. Blood and respiratory tract samples were collected, including sputum, bronchial lavage, and tracheal aspirate. Clinical specimens were inoculated onto a Sheep blood agar plate, Chocolate agar plate (aerobic with 5% CO2), and MacConkey’s agar. Identification was followed by specific and standard microbiological protocols. COVID-19 was confirmed by qualitative PCR. Antimicrobial susceptibility testing was performed using the Kirby Bauer disc diffusion method. Results: A total of 202 clinical samples, including blood, sputum, tracheal aspirates, and bronchial lavage, were collected from COVID-19-positive patients. Male patients were more common in sputum and tracheal aspirates, while female patients were more common in blood cultures. The majority of patients were over 60 years of age. Acinetobacter baumannii was predominantly isolated from blood and tracheal aspirates, exhibiting multidrug resistance, but showing complete sensitivity towards Colistin. Klebsiella pneumonia exhibited high prevalence in sputum, with complete resistance observed in Cephalosporins and Co-trimoxazole. Conclusion: The study concludes a high frequency of superadded bacterial co-infections, caused most prominently by Acinetobacter baumannii, Klebsiella pneumonia, and Pseudomonas aeruginosa. The majority of these are multidrug-resistant pathogens, therefore, urgent action is required to control the spread of nosocomial infections by resistant strains, which are responsible for the high mortality rate among COVID-19 critical patients

Factors predicting need for post-operative ventilation after microsurgical clipping of cerebral aneurysms – a multivariate analysis

Patients with aneurysmal Subarachnoid Hemorrhage (aSAH) frequently require Intensive Care Unit (ICU) beds, pre-operatively and more often, post-operatively due to the need for ventilatory support and specialized monitoring. We aimed to evaluate the frequency of post-operative ventilatory requirement in patients with aSAH and identify the possible predictive factors that might influence the need of post-operative ventilation in these patients. METHODS: We retrospectively identified a five-year data of all patients with aSAH who underwent surgical clipping using a structured proforma. Aneurysm was confirmed by Digital Subtraction Angiography (DSA) or Computerized Tomographic Angiography (CTA)

PREVALENCE AND FACTORS AFFECTING REM AND SLOW WAVE SLEEP REBOUND ON CPAP TITRATION STUDY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Background. In patients with obstructive sleep apnea syndrome (OSAS) treatment with CPAP results in an increase of REM sleep and slow wave sleep, but there is limited information about the prevalence of REM rebound in patients with OSAS and possible factors related to the rebound. Objective. REM rebound (RR) and slow wave sleep rebound (SWSR) has been described as a frequent phenomenon that occurs during CPAP titration, but the quantity that qualify for RR has not been mentioned in literature. The objective of our study was to determine the prevalence of REM rebound and slow wave sleep rebound in our sleep disorders center, to attempt to define RR and look for factors that may affect RR and SWSR on the first night of CPAP titration. Materials and methods. We included patients who had both baseline polysomnogram (bPSG) and CPAP polysomnogram (cPSG) studies done in the same laboratory. We included 179 patients>18 years with Apnea hypopnea index (AHI)>10/hr on the baseline study, with an adequate CPAP titration study. We compared the percentages of REM sleep and slow wave sleep during bPSG and cPSG. We analyzed the frequency of presentation and looked for the factors affecting RR and SWSR. Results. 179 patients were enrolled (M/F:118/61), with a mean age of 48.6±4 for men, and 51.6±12.9 for women. The mean interval between the bPSG and cPSG was 45 days. The mean REM percentage during the bPSG was 15.55 percent and during cPSG study it was 21.57 percent. We took 6 percent as our differential point as the results became statistically significant at this point (p:0001). We therefore present our data by dividing our patients population with RR6%. The mean SWS percentage during the bPSG was 8.11±9.68 and during the cPSG was 13.17±10, with a p:0.35 which is not statistically significant. The multiple regression model showed that the variables that contribute more to the REM change are: REM sleep during bPSG (-0.56), bAHI (0.24) and the body mass index (0.081). Conclusions. We suggest that an increase greater than 6% in REM sleep should be considered REM rebound, since 6.15 percent was the statistically significant difference between bPSG REM sleep and cPSG. The prevalence of RR in our group was 46 percent and the variables that contribute more to RR are REM sleep during bPSG, AHI at baseline and body mass index

Ascorbic acid augments colony spreading by reducing biofilm formation of methicillin resistant Staphylococcus aureus

Objective(s):Staphylococcus aureus is a Gram-positive pathogen, well known for its resistance andversatile lifestyle. Under unfavourable conditions, it adapts biofilm mode of growth. For staphylococcal biofilm formation, production of extracellular polymeric substances (EPS) is a pre-requisite, which is regulated by ica operon-encoded enzymes. This study was designed to know the impact of ascorbic acid on biofilm formation and colony spreading processes of S. aureus and MRSA. Materials and Methods: The isolates of methicillin-resistant S. aureus (MRSA) used in present study, were recovered from different food samples. Various selective and differential media were used for identification and confirmation of S. aureus. Agar dilution method was used for determination of oxacillin and ascorbic acid resistance level. MRSA isolates were re-confirmed by E-test and by amplification of mecA gene. Tube methods and Congo-Red agar were used to study biofilm formation processes. Gene expression studies were carried on real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Results: The results revealed the presence of mecA gene belonging to SCCmecA type IV along with agr type II in the isolates. In vitro studies showed the sub-inhibitory concentration of oxacillin induced biofilm production. However, addition of sub-inhibitory dose of ascorbic acid was found to inhibit EPS production, biofilm formation and augment colony spreading on soft agar plates. The inhibition of biofilm formation and augmentation of colony spreading observed with ascorbic acid alone or in combination with oxacillin.  Moreover, gene expression studies showed that ascorbic acid increases agr expression and decreases icaA gene expression. Conclusion:The present study concluded thatascorbic acid inhibits biofilm formation, promotes colony spreading and increases agr gene expression in MRSA