Dissemination, virulence characteristic, antibiotic resistance determinants of emerging linezolid and vancomycin-resistant Enterococcus spp. in fish and crustacean.

Enterococci are emerging nosocomial pathogens. Their widespread distribution causes them to be food contaminants. Furthermore, Enterococci can colonize various ecological niches and diffuse into the food chain via contaminated animals and foods because of their remarkable tolerance to unfavorable environmental circumstances. Due to their potential dissemination to humans, antimicrobial-resistant Enterococci in fish are a worldwide health issue. This study characterized AMR, ARGs, VAGs, gelatinase activity, and biofilm formation in Enterococcus spp. recovered from fish and seafood and evaluated potential correlations. 54 Enterococcus spp. strains(32.73 %)were isolated from 165 samples (75 Oreochromis niloticus, 30 Argyrosomus regius, and 60 Shrimp), comprising 30 Enterococcus faecalis (55.6 %) and 24 Enterococcus faecium (44.4 %) with total 32.73 % (54/165), The maximum prevalence rate of Enterococcus spp. was observed in Nile tilapia (34/54; 63 %), followed by shrimp (14/54; 25.9 %) and Argyrosomus regius (6/54; 11.1 %). The maximum prevalence rate of E. faecalis was observed in Nile tilapia (22/30; 73.3 %), followed by shrimp (8/30; 26.7 %) with significant differences. The prevalence rate of E. faecium was observed in Nile tilapia (12/24; 50 %), followed by shrimp (6/24,25 %). E. faecium is only isolated from Argyrosomus regius (6/24,25 %). Isolates exhibited high resistance against both tetracycline (90.7 %) and erythromycin(88.9 %), followed by gentamycin (77.8 %), ciprofloxacin (74.1 %), levofloxacin (72.2 %), penicillin (44.4 %), vancomycin (37 %), and linezolid (20.4 %). 50 strains (92.6 %) exhibited resistance to more than two antibiotics, 5 strains (10 %) were XDR, and the remaining 45 strains (90 %) were classified as MDR. 92.6 % of the isolates had MARindices >0.2, indicating they originated in settings with a high risk of contamination. Additionally, ten ARGs were identified, with tet(M) 92.6 %, followed by erm(B) (88.9 %), aac(6')-Ie-aph(2″)-Ia(77.8 %), tet(K) (75.9 %), gyrA (74.1 %), blaZ (48.1 %), vanA (37 %), vanB (31.5 %), optrA (20.4 %), and catA(3.7 %). Biofilm formation and gelatinase activity were observed in 85.2 %, and 61.1 % of the isolates, respectively. A total of 11 VAGs were detected, with gelE as the most prevalent (83.3 %) followed by agg(79.6 %), pil (74.1 %), both sprE and asa1 (72.2 %), hyl (70.4 %), eps(68.5 %), EF3314 (57.4 %), ace (50 %), and cylA (35.2 %) with no detection of cylB. In conclusion, the emergence of linezolid-resistant -vancomycin-resistant enterococci recovered from Egyptian fish and shrimp, suggests that fish and seafood might participate a fundamental part in the emergence of antimicrobial resistance among humans.

Physician Approaches to Antithrombotic Therapies for Recently Symptomatic Carotid Stenosis.

BACKGROUND: Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention has been well established, uncertainties remain regarding the optimal antithrombotic regimen for recently symptomatic carotid stenosis. We sought to explore the approaches of stroke physicians to antithrombotic management of patients with symptomatic carotid stenosis. METHODS: We employed a qualitative descriptive methodology to explore the decision-making approaches and opinions of physicians regarding antithrombotic regimens for symptomatic carotid stenosis. We conducted semi-structured interviews with a purposive sample of 22 stroke physicians (11 neurologists, 3 geriatricians, 5 interventional-neuroradiologists, and 3 neurosurgeons) from 16 centers on four continents to discuss symptomatic carotid stenosis management. We then conducted thematic analysis on the transcripts. RESULTS: Important themes revealed from our analysis included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and the choice of antiplatelet therapy while awaiting revascularization. There was a greater concern for adverse events while using multiple antiplatelet agents (e.g., dual-antiplatelet therapy (DAPT)) in patients undergoing carotid endarterectomy compared to carotid artery stenting. Regional variations included more frequent use of single antiplatelet agents among European participants. Areas of uncertainty included antithrombotic management if already on an antiplatelet agent, implications of nonstenotic features of carotid disease, the role of newer antiplatelet agents or anticoagulants, platelet aggregation testing, and timing of DAPT. CONCLUSION: Our qualitative findings can help physicians critically examine the rationale underlying their own antithrombotic approaches to symptomatic carotid stenosis. Future clinical trials may wish to accommodate identified variations in practice patterns and areas of uncertainty to better inform clinical practice.

Disseminated tuberculosis: Clinical presentation, diagnosis, and outcomes in a tertiary-care hospital in Saudi Arabia.

Background: Tuberculosis (TB) is the primary infectious cause of mortality worldwide. Although TB incidence and prevalence are declining, the use of immunosuppressive drugs and the growing prevalence of immunocompromising conditions such as comorbidities, malignancies, and the use of immunosuppressive agents are risk factors for disseminated TB (DTB). This study aims to identify the relevant clinical, laboratory, radiological, and histopathological features of DTB, as well as to assess the typical anatomical distributions and treatment outcomes of patients diagnosed with the disease at King Abdulaziz Medical City (KAMC). Methods: A retrospective chart review was conducted, including all patients diagnosed with miliary or DTB at KAMC with retrievable medical files. Results: The study included 55 patients, of whom 35 (63.6%) were male and the median age was 64 years old. 35 (63.6%) of the infected patients were timely diagnosed and eventually cured from the illness. The most common comorbid conditions were diabetes, chronic kidney disease, and immunocompromising conditions, which were present in 37 (67.2%), 12 (21.8%), and 11 (20%) of the patients, respectively. The most common presenting symptoms were fever and cough, present in 31 (56.3%) and 26 (47.2%) of the patients, respectively, followed by weight loss in 25 (45.4%), night sweats in 15 (27.2%), and shortness of breath in 14 (25.4%). Approximately two-thirds of the patients had pulmonary miliary TB (MTB) (38; 69.1%), followed by TB lymphadenitis (21; 38.2%), central nervous system involvement (13; 23.6%), skeletal involvement (11; 20%), gastrointestinal involvement (5; 9.1%), pleural involvement (3; 5.5%), and urogenital TB (2; 3.6%). The mortality rate was 14 (25.5%) patients. Conclusion: MTB is challenging to diagnose due to nonspecific clinical, laboratory, and imaging findings. Clinicians dealing with patients who are at risk of developing DTB should be aware of the typical presentations and abnormal clinical findings. They should also have a low threshold to initiate specific investigations for the disease, as early diagnosis and effective treatment is critical in reducing morbidity and mortality rates.

Mission possible: open innovation in nursing and patient care services at Massachusetts General Hospital.

OBJECTIVES: Although front-line nurses and staff are uniquely positioned to identify the inefficiencies and gaps in care delivery, formal processes are not always in place to hear from those very employees. DESIGN: We established a scalable process that embodies open innovation principles, to broaden and distribute the innovation locus. SETTING: Massachusetts General Hospital, Boston, MA. PARTICPITANTS: We invited 8800+ nurses and other direct caregivers to participate in organisational problem solving. INTERVENTIONS: We solicited employees to (1) identify pain points and develop solutions and (2) crowd vote to indicate which ideas they want to see implemented. RESULTS: 177 employees submitted 225 ideas, and 928 cast a vote. The 40 participants who submitted top-voted ideas were invited to develop a detailed implementation plan; of those, 27 submitted one. Four ideas emerged as winners. CONCLUSIONS: Formulating a clear call for ideas, securing leadership buy-in and generating excitement about the process were essential to our efforts. Challenges associated with opening the innovation process involved managing a large volume of participants and submissions, and providing on-the-go training to nurses and staff who were not used to being asked to participate in organisational problem solving.

Future scope of plant-derived bioactive compounds in the management of methicillin-resistant Staphylococcus aureus: In vitro antimicrobial and antivirulence prospects to combat MRSA.

Methicillin-resistant Staphylococcus aureus (MRSA) is a foremost human and animal pathogen with public health and veterinary significance causing hospital and community infections and contagious bovine mastitis. Due to its ability to develop multidrug resistance (MDR) and its pathogenicity, MRSA infection control is becoming a global concern. Natural antibacterial options are needed to combat MDR development and infectious dissemination. This study investigated the antimicrobial resistance and virulence genes profiling of MRSA isolates and explored the antivirulence efficacy of trans-cinnamaldehyde, thymol, and carvacrol essential oils (EOs) against multivirulent and MDR-MRSA isolates. Thirty six S. aureus isolates (25%) were retrieved, of which 34 (94.4%) were MRSA. A high prevalence of MDR (66.7%) was monitored and all 53 molecularly verified isolates possessed icaA and cna virulence genes. Moreover, 94.1% of these isolates were multivirulent with 23.5% of them carrying icaA, cna, eta, tst, and sea virulence genes. Our data proved superior in vitro antimicrobial and antivirulence activities of trans-cinnamaldehyde, thymol, and carvacrol. They inhibited the growth of multi-virulent and MDR-MRSA isolates and downregulated the transcription of examined virulence genes. Our study suggests using EOs as prospective antimicrobials with excellent antivirulence activities against MRSA isolates. We provided data regarding the eventual role of phytogenics in prevention and control of MRSA infection.

The Effect of Topical Agents on the Tensile Strength of Absorbable and Non-absorbable Suture Materials-An in Vitro Study.

INTRODUCTION: Topical agents are sometimes applied to surgical wounds after closure; these may include antiseptics or antibiotics. Minimal research has been undertaken to investigate the effect of topical regimens on the tensile strength of suture materials. AIM: To investigate the effect of four commonly used wound care regimens on the tensile strength of suture materials. METHODS: The failure load of 9 different suture materials was tested using the Instron Electroplus E3000 tensile testing machine (Instron Corporation, Norwood, Massachusetts). Tensile strength was represented as the failure load, measured in Newtons (N), and defined as the maximal load that could be applied across the suture prior to failure. Each suture was tested dry and after immersion in one of 4 products for 7 days and tested on day 7. The immersion agents tested were: sodium chloride 0.9%, MicroSafe® (Sonoma Pharmaceuticals, Petaluma, CA), Aqueous Povidone-iodine 10% solution (Betadine-Mundipharma), and Fucidin ointment. RESULTS: Sodium chloride 0.9%, MicroSafe®, Aqueous Povidone-iodine 10%, and Fucidin seem to increase the failure load of most absorbable and non-absorbable sutures. However, the failure load of Polyglactin 910 suture (Surgilactin, coated, violet-Ethicon) is reduced by long-term exposure to either sodium chloride 0.9% or MicroSafe®, while the failure load of the Polydioxanone suture (PDS Plus-Ethicon) is reduced by long-term exposure to MicroSafe® only. CONCLUSION: In our experiment, the commonly used wound care products have been shown to alter the tensile strength of suture materials. Further human studies are required to ascertain the clinical validity and applicability of our findings.

Response to Lisinopril in Patients with Sickle Cell Anemia and Proteinuria.

Proteinuria is a manifestation of sickle cell anemia (SCA)-related renal disease and is a risk factor of renal impairment. Angiotensin-converting enzyme (ACE) inhibitors have benefits, but their role in SCA remains undefined. This study aimed to assess the role of lisinopril, an ACE inhibitor, in reducing proteinuria in SCA patients. Thirty-five patients older than 15 years with known SCA (HbSS or HbS-ß0) and a 24-h urinary protein level of 150 mg or more participated in this study. Urine was collected over 24 h to quantify proteinuria. The patients had a mean age of 28.5 ± 6.98 years. The median 24-h urinary protein before treatment was 0.3006 g and that after treatment was 0.150 g (P = 0.01). After a median follow-up of 38 months, 24-h urinary protein decreased in 27 (77%) patients and normalized in 18 (52%) patients. Urinary protein increased in 2 (6%) patients and remained stable (no change) in 6 (17%) patients. There was no significant difference in blood pressure (BP) before and after treatment. The average dose of lisinopril was 5 mg. Twenty patients were still on lisinopril at last follow-up. The reasons for stopping lisinopril included normalization of protein, noncompliance, adverse effects, and pregnancy. Lisinopril effectively reduced proteinuria in SCA patients, without significantly reducing BP. Only a few patients developed adverse effects, including coughing, dizziness, and diarrhea. It is unclear how long lisinopril should be continued and whether it can be stopped in patients with normalized urinary protein.

Gut microbiota analyses of Saudi populations for type 2 diabetes-related phenotypes reveals significant association.

BACKGROUND: Large-scale gut microbiome sequencing has revealed key links between microbiome dysfunction and metabolic diseases such as type 2 diabetes (T2D). To date, these efforts have largely focused on Western populations, with few studies assessing T2D microbiota associations in Middle Eastern communities where T2D prevalence is now over 20%. We analyzed the composition of stool 16S rRNA from 461 T2D and 119 non-T2D participants from the Eastern Province of Saudi Arabia. We quantified the abundance of microbial communities to examine any significant differences between subpopulations of samples based on diabetes status and glucose level. RESULTS: In this study we performed the largest microbiome study ever conducted in Saudi Arabia, as well as the first-ever characterization of gut microbiota T2D versus non-T2D in this population. We observed overall positive enrichment within diabetics compared to healthy individuals and amongst diabetic participants; those with high glucose levels exhibited slightly more positive enrichment compared to those at lower risk of fasting hyperglycemia. In particular, the genus Firmicutes was upregulated in diabetic individuals compared to non-diabetic individuals, and T2D was associated with an elevated Firmicutes/Bacteroidetes ratio, consistent with previous findings. CONCLUSION: Based on diabetes status and glucose levels of Saudi participants, relatively stable differences in stool composition were perceived by differential abundance and alpha diversity measures. However, community level differences are evident in the Saudi population between T2D and non-T2D individuals, and diversity patterns appear to vary from well-characterized microbiota from Western cohorts. Comparing overlapping and varying patterns in gut microbiota with other studies is critical to assessing novel treatment options in light of a rapidly growing T2D health epidemic in the region. As a rapidly emerging chronic condition in Saudi Arabia and the Middle East, T2D burdens have grown more quickly and affect larger proportions of the population than any other global region, making a regional reference T2D-microbiome dataset critical to understanding the nuances of disease development on a global scale.

RELATIONSHIP BETWEEN SOME INFLAMMATORY MARKERS AND BACTERIAL INFECTIONS AMONG COVID-19 PATIENTS.

Fifty blood samples were collected from patients who were confirmed to have COVID-19 by conducting a diagnostic test using real-time RT-PCR for the direct qualitative detection of the Coronavirus when the patients attended the private clinics at Al Rabeea Private Hospital in Mosul for the period from the beginning of March to the end of May 2021. The patients' ages range from17-59 years, with 23 males (46%), and 27 females (54%). The blood samples were taken before giving any type of treatment for blood culture, biochemical, and immunological tests. Bacteremia is investigated to determine the types of bacteria that cause bacteremia, biochemical tests such as D-dimer, S. Ferritin, CRP, Protein S, Protein C, FBS, LDH, Blood Urea, Serum Creatinine, SGOT & SGPT, and immunological tests such as blood group, IgG & IgM, IL-1B, IL-6, TNF-α alpha, ASOT, ESR, C3, and C4. In this study, the relationship between bacteremia and the types of biomarkers used is determined in addition to the relationship of bacteremia to the patient's age, sex, SPO2, and body temperature. More accurate comparison is also accomplished in cases of bacteremia by adopting the types of bacteria isolated if they were gram-positive or gram-negative. The results of this study show an increase in the severity of COVID-19 disease caused by a secondary bacterial infection. This is determined by measuring several biomarkers used in this study and also by performing bacteriological tests to document bacteremia by blood culture. Also, these results can be adopted in future studies concentrating on the molecular level to determine the genetic changes associated with viral infection with or without secondary bacterial infection to develop an effective treatment protocol.

Factors Influencing Undergraduate Students' Preference of Health Sciences Specialties.

Background: It is necessary to determine what motivates students to pursue a particular specialty of their choosing to maintain a balance of medical practitioners from various disciplines. Objective: The study aims to assess factors influencing undergraduate students of Applied Medical Sciences in choosing a specialty or discipline. Methods: This cross-sectional study was conducted among first-year students of the faculty of applied medical sciences at Taibah University. One hundred and twenty-five participants were enrolled in the study. The students were asked to respond and complete the designed 9-item questionnaire. The Statistical Package for the Social Sciences (BM SPSS Statistics for Windows, Version 23.0, Armonk, NY: IBM Corp.) was used to analyze the data. A comparison between departments of the faculty was carried out. Results: 125 participants were satisfied with their current faculty or discipline. They stated that medicine was the first choice (43.2%), followed by clinical nutrition (11.2%), dentistry (8%), diagnostic radiology (7.2%), and clinical laboratory (5.6%). The most important factors that affect students' choice of discipline were helping patients and the community (32.8%), personal desire (30.4%), personal desire and helping patients (22.4%), and job opportunity and prestige (9.5%), with gender variations. Family enforcement and finances were less frequent factors affecting students' specialty preferences. Conclusion: The human medicine specialization was the first choice for most female and male undergraduate students who entered the faculty of applied medical sciences. Furthermore, the most influencing factor affecting students' choices was helping patients and the community.

Correction to: Exploring the impact of air pollution on COVID-19 admitted cases: Evidence from vector error correction model (VECM) approach in explaining the relationship between air pollutants towards COVID-19 cases in Kuwait.

[This corrects the article DOI: 10.1007/s42081-022-00165-z.].

Exploring the impact of air pollution on COVID-19 admitted cases: Evidence from vector error correction model (VECM) approach in explaining the relationship between air pollutants towards COVID-19 cases in Kuwait.

In urban areas, air pollution is one of the most serious global environmental issues. Using time-series approaches, this study looked into the validity of the relationship between air pollution and COVID-19 hospitalization. This time series research was carried out in the state of Kuwait; stationarity test, cointegration test, Granger causality and stability test, and test on multivariate time-series using the Vector Error Correction Model (VECM) technique. The findings reveal that the concentration rate of air pollutants ( O 3 , SO 2 , NO 2 , CO , and PM 10 ) has an effect on COVID-19 admitted cases via Granger-cause. The Granger causation test shows that the concentration rate of air pollutants ( O 3 , PM 10 , NO 2 , temperature and wind speed) influences and predicts the COVID-19 admitted cases. The findings suggest that sulfur dioxide ( SO 2 ), NO 2 , temperature, and wind speed induce an increase in COVID-19 admitted cases in the short term according to VECM analysis. The evidence of a positive long-run association between COVID-19 admitted cases and environmental air pollution might be shown in the cointegration test and the VECM. There is an affirmation that the usage of air pollutants ( O 3 , SO 2 , NO 2 , CO , and PM 10 ) has a significant impact on COVID-19-admitted cases' prediction and its explained about 24% of increasing COVID-19 admitted cases in Kuwait.

Approach and Clinical Practice of Functional Movement Disorders Among Neurologists in Saudi Arabia.

Background Functional movement disorders (FMDs) are neurological disorders that consist of abnormal and involuntary movements that have no specific organic cause. Given the prevalence of FMDs and the scarcity of information on neurologists' approaches to FMDs, we aimed to assess the neurologists' approaches and clinical practice in managing FMDs in Saudi Arabia. Methods A validated online questionnaire in English was used. The data were collected through a self-reported questionnaire. The data were analyzed using the statistical software IBM SPSS version 22 (SPSS, Inc., Armonk, NY). Results A total of 231 neurologists completed the study survey. A total of 129 (55.8%) were males. Regarding the predictors for a diagnosis other than FMD, the highest rating predictor was for evidence of physical injury and lack of psychiatric history of psychological stressors, while the lowest rating was for the male gender. Regarding the effective treatment strategies of FMD, the most effective treatment strategy reported by the clinicians was patient education, while the least was alternative or complementary medicine. The management ability of clinicians was generally restricted by cultural beliefs about psychological illnesses and the availability of referral services. The reported predictors by clinicians for a better prognosis of FMD include acceptance of the diagnosis by the patient followed by identification and management of psychological stressors and concurrent psychiatric disorder and a supportive social network. Generally, the most used terminology in this study was "functional movement disorder". Conclusions There is a variation in the approach and clinical practice of FMD among neurologists in Saudi Arabia. Shared knowledge regarding diagnosis and effective management is crucial. Collaborative efforts are required to establish practice guidelines in the future.

Physical exercise and cortical thickness in healthy controls: a pilot study.

OBJECTIVE: Physical exercise has showed potential in improving brain function and increase in cortical size. This study aims to assess the cortical changes that are associated with physical exercise. SUBJECTS AND METHODS: We investigated 45 subjects; 25 of them involved in exercise group and 20 in non-exercise group. The exercise group underwent 6 months of intervention consisting of 40 minutes (min) of aerobic exercise and 20 minutes of anaerobic exercise. Magnetic resonance imaging (MRI) scans were acquired from both groups to measure the thickness of the cortex and was assessed with FreeSurfer software. RESULTS: Exercise group demonstrated significantly increased cortical thickness in the left pericalcarine area, left superior parietal area, right rostral middle frontal and right lateral occipital gyrus compared to non-exercise group. CONCLUSIONS: Regular and continuous physical exercise can enhance brain structures. The current findings have important implications for understanding the effect of physical activity or fitness programs on the brains of healthy individuals and of patients with a range of conditions.

Genetic Analysis, Population Structure, and Characterisation of Multidrug-Resistant Klebsiella pneumoniae from the Al-Hofuf Region of Saudi Arabia.

Multidrug-resistant Klebsiella pneumoniae (MDR-KP) is a major public health problem that is globally associated with disease outbreaks and high mortality rates. As the world seeks solutions to such pathogens, global and regional surveillance is required. The aim of the present study was to examine the antimicrobial susceptibility pattern and clonal relatedness of Klebsiella pneumoniae isolates collected for a period of three years through pulse field gel electrophoresis (PFGE). Isolate IDs, antimicrobial assays, ESBL-production, and minimum inhibitory concentrations (MICs) were examined with the Vitek 2 Compact Automated System. IDs were confirmed by 16S rRNA gene sequencing, with the resulting sequences being deposited in NCBI databases. DNA was extracted and resistance genes were detected by PCR amplification with appropriate primers. Isolates were extensive (31%) and multidrug-resistant (65%). Pulsotype clusters grouped the isolates into 22 band profiles that showed no specific pattern with phenotypes. Of the isolates, 98% were ESBL-KP, 69% were carbapenem-resistant Enterobacteriaceae (CRE) strains, and 72.5% comprised the carriage of two MBLs (SIM and IMP). Integrons (ISAba1, ISAba2, and IS18) were detected in 69% of the MDR-KP. Additionally, OXA-23 was detected in 67% of the isolates. This study therefore demonstrates clonal diversity among clinical K. pneumoniae, confirming that this bacterium has access to an enormous pool of genes that confer high resistance-developing potential.

Physical exercise keeps the brain connected by increasing white matter integrity in healthy controls.

ABSTRACT: Physical exercise leads to structural changes in the brain. However, it is unclear whether the initiation or continuous practice of physical exercise causes this effect and whether brain connectivity benefits from exercise. We examined the effect of 6 months of exercise on the brain in participants who exercise regularly (n = 25) and in matched healthy controls (n = 20). Diffusion tensor imaging brain scans were obtained from both groups. Our findings demonstrate that regular physical exercise significantly increases the integrity of white matter fiber tracts, especially those related to frontal function. This implies that exercise improves brain connectivity in healthy individuals, which has important implications for understanding the effect of fitness programs on the brains of healthy subjects.

Handling missing data in a rheumatoid arthritis registry using random forest approach.

Missing data in clinical epidemiological research violate the intention-to-treat principle, reduce the power of statistical analysis, and can introduce bias if the cause of missing data is related to a patient's response to treatment. Multiple imputation provides a solution to predict the values of missing data. The main objective of this study is to estimate and impute missing values in patient records. The data from the Kuwait Registry for Rheumatic Diseases was used to deal with missing values among patient records. A number of methods were implemented to deal with missing data; however, choosing the best imputation method was judged by the lowest root mean square error (RMSE). Among 1735 rheumatoid arthritis patients, we found missing values vary from 5% to 65.5% of the total observations. The results show that sequential random forest method can estimate these missing values with a high level of accuracy. The RMSE varied between 2.5 and 5.0. missForest had the lowest imputation error for both continuous and categorical variables under each missing data rate (10%, 20%, and 30%) and had the smallest prediction error difference when the models used the imputed laboratory values.

In-hospital mortality in SARS-CoV-2 stratified by hemoglobin levels: A retrospective study.

This study is to estimate in-hospital mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients stratified by hemoglobin (Hb) level. Patients were stratified according to hemoglobin level into two groups, that is, Hb <100 g/L and Hb >100 g/L. A total of 6931 patients were included. Of these, 6377 (92%) patients had hemoglobin levels >100 g/L. The mean age was 44 ± 17 years, and 66% of the patients were males. The median length of overall hospital stay was 13 days [2; 31]. The remaining 554 (8%) patients had a hemoglobin level <100 g/L. Overall mortality was 176 patients (2.54%) but was significantly higher in the group with hemoglobin levels <100 g/L (124, 22.4%) than in the group with hemoglobin levels >100 g/L (52, 0.82%). Risk factors associated with increased mortality were determined by multivariate analysis. The Kaplan-Meier survival analysis showed hemoglobin as a predictor of mortality. Cox proportional hazards regression coefficients for hemoglobin for the HB ≤ 100 category of hemoglobin were significant, B = 2.79, SE = 0.17, and HR = 16.34, p < 0.001. Multivariate logistic regression showed Hb < 100 g/L had a higher cumulative all-cause in-hospital mortality (22.4% vs. 0.8%; adjusted odds ratio [aOR], 0.33; 95% [CI]: [0.20-0.55]; p < 0.001). In this study, hemoglobin levels <100 g/L were found to be an independent predictor of in-hospital mortality.

Biosynthesized Iron Oxide Nanoparticles from Petroselinum crispum Leaf Extract Mitigate Lead-Acetate-Induced Anemia in Male Albino Rats: Hematological, Biochemical and Histopathological Features.

This study aimed to investigate the ameliorative effects of iron oxide nanoparticles (IONPs) prepared from leaf extract of Petroselinum crispum compared to those prepared using a chemical method in lead-acetate-induced anemic rats. Twenty rats were divided into four groups (five rats each). Throughout the experimental period (8 weeks), the rats in group 1 were not given any therapy. The rats in groups 2, 3 and 4 were given 400 ppm lead acetate orally for 2 weeks to make them anemic. Following that, these rats were either left untreated, given 27 ppm of chemical IONPs orally or given 27 ppm of natural IONPs orally for the remaining 6 weeks of the experiment. TEM analysis indicated that the chemically and naturally prepared IONPs had sizes of 6.22-9.7 and 64-68 nm, respectively. Serum ferritin and iron concentrations were reduced, whereas the total iron-binding capacity (TIBC), ALT, AST, urea and creatinine were significantly increased in the non-treated lead-acetate-induced anemic rats compared to those of the control. In addition, congestion, hemorrhage, necrosis, vacuolation and leukocytic infiltration in the kidneys, liver and spleen were observed in non-treated lead-acetate-induced anemic rats compared to the control. The effects of lead acetate were mitigated by IONPs, particularly the natural one. In conclusion, IONPs produced from Petroselinum crispum leaf extract can be used as an efficient and safe therapy in lead-acetate-induced anemic rats.