Background In COVID-19 patients, undetected co-infections may have severe clinical implications associated with increased hospitalization, varied treatment approaches and mortality. Therefore, we investigated the implications of viral and bacterial co-infection in COVID-19 clinical outcomes. Methods Nasopharyngeal samples were obtained from 48 COVID-19 patients (29% ICU and 71% non-ICU) and screened for the presence of 24 respiratory pathogens using six multiplex PCR panels. Results We found evidence of co-infection in 34 COVID-19 patients (71%). Influenza A H1N1 (n = 17), Chlamydia pneumoniae (n = 13) and human adenovirus (n = 10) were the most commonly detected pathogens. Viral co-infection was associated with increased ICU admission (r = 0.1) and higher mortality (OR 1.78, CI = 0.38–8.28) compared to bacterial co-infections (OR 0.44, CI = 0.08–2.45). Two thirds of COVID-19 critically ill patients who died, had a co-infection; and Influenza A H1N1 was the only pathogen for which a direct relationship with mortality was seen (r = 0.2). Conclusions Our study highlights the importance of screening for co-infecting viruses in COVID-19 patients, that could be the leading cause of disease severity and death. Given the high prevalence of Influenza co-infection in our study, increased coverage of flu vaccination is encouraged to mitigate the transmission of influenza virus during the on-going COVID-19 pandemic and reduce the risk of severe outcome and mortality.

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Background Primary ciliary dyskinesia (PCD) is a ciliopathy with diverse clinical and genetic findings caused by abnormal motile cilia structure and function. In this study, we describe the clinical characteristics of confirmed PCD cases in our population and report the radiological, genetic, and laboratory findings. Methods This was a retrospective, observational, single-centre study. We enrolled 18 patients who were diagnosed with confirmed PCD between 2015 and 2019. We then analyzed their data, including clinical findings and workup. Results In our cohort, 56% of patients had molecularly confirmed PCD, and RSPH9 was the most common gene identified. Transmission electron microscopy (TEM) showed an ultrastructural defect in 64% of samples, all of which matched the genetic background of the patient. Situs inversus (SI) was observed in 50% of patients, and congenital heart disease was observed in 33%. The median body mass index (BMI) was 15.87 kg/m 2 , with a median z score of -1.48. The median FEV1 value was 67.6% (z score - 2.43). Radiologically, bronchiectasis was noted in 81% of patients at a variable degree of severity. Lung bases were involved in 91% of patients. We were unable to correlate the genotype-phenotype findings. Conclusion We describe the clinical and molecular characteristics of patients with confirmed PCD in a tertiary centre in Saudi Arabia and report 9 new pathogenic or likely pathogenic variants in one of the PCD-associated genes.

ABSTRACT… Background: Internal jugular vein is considered the preferred site of insertion. Prevalence of central vein stenosis following temporary double lumen catheterization at different sites seems to be different in Asian countries. Objectives: To evaluate the number of cases having catheterization and stenosis after being subjected to central vein catheterization (CVC) among Pakistani population. Study Design: Cross sectional study. Period: 6 months period. Setting: Admitted in the Department of Nephrology or already undergoing maintenance hemodialysis fulfilling the inclusion criteria were included in the study. Material and Method: The sample which was considered suitable for this study was 150 cases after checking the inclusion criteria carefully. The patients were advised to undergo color Doppler ultrasonography of IJV and SCV of both sides. Demographics and outcome variables were noted and recorded for the analysis purposes. Data was analyzed used SPSS 20.inc Results: The frequency of catheterization of catherization at IJV was found to be 128(85.3%) and frequency of catheterization at SCV was 22(14.7%). The frequency of CVS at IJV was found to be 43(29.68%) and the frequency of CVS at SCV was 81(54.54%). The frequency of stenosis at SCV was found to be significantly higher with a p value of 0.029 (<0.05). Conclusion: Internal jugular vein is the most frequent and preferred site of temporary double lumen catheterization for haemodialysis as it is associated with significantly lower rate of stenosis as compared to subclavian vein.

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Background: Primary ciliary dyskinesia is a rare genetic disorder characterized by recurrent sinopulmonary infections and worsening obstructive lung disease. Kidney and brain involvement is less common and is associated with overlapping ciliopathies/syndromes. The lungs are impacted early in the course of the disease, so it is vital to monitor lung function and recognize any decline by doing appropriate lung function tests. This systematic review compares different lung function tests and analyzes which one becomes abnormal earlier in the disease.Methods: A systematic review was conducted following the methodology in the "Cochrane Handbook on Systematic Reviews for diagnostic tests." The Preferred Reporting Items for Systematic Review and Meta-Analyses were used to report the results. The risk of bias assessment was done using "The Cochrane Handbook for Systematic Reviews tool for interventional studies." A meta-analysis was not performed due to the small sample size. All studies were analyzed by using Joanna Briggs Institute's critical appraisal tool.Results: After screening for the duplication of results and applying inclusion and exclusion criteria, 14 studies were assessed by reading the full texts. Out of these, eight were finally included in this systematic review. The total sample size from all studies was 165, including 80 males. All the studies used spirometry as a lung function test, whereas multiple breath washout was used in five studies. Other tests used for comparison were computed tomography (CT), magnetic resonance imaging (MRI), cardiopulmonary exercise testing, 6-min walk test, DLCO, maximal inspiratory pressure, maximal expiratory pressure, and PaO 2 . Lung clearance index (LCI) by multiple breath washout had a stronger association with the structural changes on CT/MRI than spirometry indices like forced expiratory volume in 1 s (FEV1) and forced expiratory flow at 25% to 75% of lung volume .Conclusions: Based on the evidence from this systematic review, LCI becomes abnormal earlier than FEV1 or FEF 25-75 and positively correlates with the findings

To increase the green performance of an organization Green Transformational Leadership is very important. This study mainly focuses the impact on Green Performance of Green Transformational Leadership by considering the mediating effect of Green Self-Efficacy and Green Mindfulness.The study is descriptive and quantitative in nature. Survey questionnaire method was used and data have been collected from 200 respondents by applying simple random sampling technique. After applying required tests on AMOS and SPSS, findings revealed that transformational leadership has asignificant and positive impact on Green performance. Moreover, a result also enlightened that Green Mindfulness and Green Self-efficacy significantly and moderately mediates the relationship between Green Performance and transformational leadership. At the end, this article implementation, suggestion, and limitation have also been included for further researches.

Campylobacter species are known to cause enteritis. However, over the past 40–50 years, there have been reports of varying presentations, such as cellulitis, spondylodiscitis and bacteraemia. Of the Campylobacter species, Campylobacter jejuni is the most common culprit for causing bacteraemia, however, Campylobacter coli bacteraemia is becoming more prevalent. Here, we discuss an unusual case of C. coli bacteraemia in a patient with decompensated liver cirrhosis.