Background The pandemic of coronavirus disease (COVID-19) has caused huge number of patients admitted to intensive care units (ICUs) in a critical need to mechanical ventilation. Ventilator associated pneumonia (VAP) has been noticed as a common complication in these patients with unfavorable outcomes. The current study aimed to assess bacterial and fungal VAP in COVID-19 patients admitted to ICUs during the second wave and to identify the possible risk factors. Methods Respiratory samples were collected from 197 critically ill COVID-19 patients under mechanical ventilation. Bacterial and fungal superinfections were diagnosed by microbiological cultures with subsequent antimicrobial susceptibility testing of the isolates using available kits. Results All specimens 197/197 (100%) were positive for bacterial infections, while fungal elements were detected in 134/197 (68%) of specimens. The most frequently isolated bacteria were pan drug resistant (PDR) Klebsiella pneumoniae (41.1%), followed by multi drug resistant (MDR) Acinetobacter baumannii (27.4%). On the other hand, Candida species represented the most frequently isolated fungi (75.4%) followed by molds including Aspergillus (16.4%) and Mucor (8.2%) species. Possible risk factors for fungal VAP included underlying diabetes mellitus (95% confidence interval [CI] 1.09−3.31; p = 0.02), chest disease (95% CI 1.01−3.32; p = 0.05), hypothyroidism (95% CI 1.01−4.78; p = 0.05), and longer duration of mechanical ventilation (p < 0.001). Furthermore, all patients 134/134 (100%) who developed fungal VAP, were already under treatment with corticosteroids and Tocilizumab. Conclusion Bacterial and fungal VAP in critically ill COVID-19 patients is a serious problem in the current pandemic. Urgent and strategic steps to keep it under control are compulsory.

No abstract

Background Ulcerative colitis is a heterogeneous disease in terms of disease course, location, and therapeutic response. The current study was done to assess the alteration of the gut microbiome in UC patients and its relationship to severity, response to therapy, and outcome. Patients and methods The study included 96 participants who were divided into a case group (n = 48, recent onset, treatment naive ulcerative colitis patients who were subdivided into mild, moderate, and severe subgroups based on Truelove–Witts and endoscopic severity) and a healthy control group (n = 48). All were subjected to a thorough history, clinical examination, colonoscopy, routine laboratory tests, and quantitative real-time PCR to quantify Bacteroides, Lactobacilli, Faecalibacterium prausnitzii, Veillonella, and Hemophilus in fecal samples at baseline and 6 months after treatment. Results Bacterial 16S rRNA gene sequencing revealed a significant reduction in the phylum Firmicutes in UC patients, with a significant predominance of the phylum Bacteriodetes. F. prausnitzii and lactobacilli were inversely proportional to disease severity, whereas Bacteroides, Hemophilus, and Veillonella were directly proportional to it. Six months after therapy, a statistically significant increase in F. prausnitzii and lactobacilli was observed, with a decrease in the levels of other bacteria. Lower baseline F. praustinizii (< 8.5) increased the risk of relapse; however, lower ESR (< 10), lower post-treatment CRP (< 6), lower Bacteroides (< 10.6) indefinitely protect against relapse. Conclusion The gut microbiome of recently diagnosed UC showed lower levels of Lactobacilli, Faecalibacterium, and higher levels of Bacteroides and Veillonella, and the change in their levels can be used to predict response to therapy.

Background: Pathophysiology of rheumatoid arthritis (RA) is an undetermined complex mechanism which include interaction between genetic, environmental and immunological factors. Recent studies suggest a possible role for gut microbiome in the pathogenesis. Objectives: To assess the alteration of fecal Bacteroids, Lactobacilli, and Prevotella genera among RA patients. Methods: Stool samples were collected from 25 patients newly diagnosed as RA (RA group) and 25 healthy controls (control group) for quantitation of Bacteroids, Lactobacilli, and Prevotella genera by real time PCR. Results: The intestinal microbiome of RA group was significantly altered. We reported a significant enrichment of the bacterial Lactobacilli genus in RA patients (16.206% vs 1.5%; P<0.001). Bacteroids and Prevotella genera showed lower percentages in RA patients compared to the controls (1.113% vs 2.7 %; 3.157% vs 17% respectively, P= 0.018, P<0.001 respectively). Conclusion: Predominance of Lactobacilli genus with the lower levels of Bacteroids and Prevotella, in recently diagnosed RA patients, could indicate the role of gut dysbiosis in the pathoghysiology of RA.

Background: 1, 25-dihydroxy vitamin D3 (VitD3) can improve the effect of allergenspecific immunotherapy (SIT). Few data is available about its role in childhood asthma. Objective: To assess the immunological and clinical efficacy of VitD3 as an adjuvant to allergen specific immunotherapy in pediatric asthma. Methodology: Sixty nine children with atopic asthma were divided into three groups: a group received subcutaneous immunotherapy (SCIT) in combination with VitD3 (n=23), another group received SCIT alone (n=23), and the last group VitD3 alone (n=23). All children were assessed at baseline, and six months for rate of inhaled corticosteroid (ICS) discontinuation, and serum levels of IL-10, and IL-17A. Results: In the SCIT + vitD3, ICS discontinuation rate was higher compared to VitD3 alone group and SCIT alone group at the end of 6th month (P=0.555 and 0.016 respectively). The combined SCIT+ VitD3 group showed significant increase of serum IL-10 level in comparison to SCIT alone group and VitD3 alone group (P=0.000) and significant decrease in serum IL-17A level compared to VitD3 alone group (P= 0.011) Conclusion: VitD3 enhance the clinical and immunological outcomes of SIT in pediatric asthma. Further investigation is needed to evaluate this effect in a larger scale to confirm its role as an adjunct to SIT.