Background: Amantadine has been proposed to inhibit E-channel conductance in reconstituted lipid bilayers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to study whether patients on amantadine have altered risks of contracting COVID-19 infection.Methods: We conducted a hospital-based, observational, retrospective cohort study using data for patients on amantadine supported by data given by the patients through an online questionnaire. We included registered amantadine users in our hospital for 6 months or more on March 1, 2020, and non-amantadine users to act as the control group. We used forced entry, multiple logistic regression models to estimate adjusted ORs for amantadine adjusting for the confounders.Findings: Between September 1, 2019, and March 1, 2020, 212 patients with Parkinson's disease (PD) or multiple sclerosis (MS) received greater than one equal to two prescriptions of amantadine. We selected a random sample of diagnoses which matched 424 patients of non-amantadine users (1:2) as a control group (424 patients). Between March 1, 2020, and March 1, 2021, 256 patients responded to our online questionnaire, 87 patients were on amantadine (group I), and 169 patients were not (control group, group II). COVID-19 disease infection proved to be 5.7 and 11.8% in group I and II patients, respectively. Increased odds of COVID-19 in multivariable-adjusted models were associated with old age and history of contact with COVID cases. Amantadine was associated with a significantly reduced risk of COVID-19 disease infection (adjusted OR 0.256, 95% CI 0.074–0.888).Interpretation: Amantadine is associated with a reduced risk of COVID-19 infection after adjusting for a broad range of variables. History of contact with COVID cases and old age are risk factors for COVID-19 infection. Therefore, we recommended randomized clinical trials investigating amantadine use for the prevention of COVID-19.
Background: Herpes zoster (HZ) is a medical condition of a significant global impact, with millions of people affected and rising incidence. Some risk factors of this disease had been reported in previous literatures worldwide; however, studies that pool evidence to provide estimates of newly emerged risk have yet to be conducted, especially in the context of the current pandemic. Therefore, the purpose of this study is to examine the association between COVID-19 vaccination and the risk of developing HZ in Kuwait. Methods: Clinically diagnosed 186 HZ patients were enrolled, along with 186 controls (1:1) with matched age (± 5years), sex and nationality. Data from cases and controls was collected using a predesigned interview questionnaire. The data was analyzed using logistic regression. Results: Most of cases and controls were non-Kuwaiti (61.8%) and male (69.4%). About one fifth (19.4%) of HZ cases developed HZ following vaccination against COVID-19 within the study period (two months). Cases were more likely than controls to have had COVID-19 vaccination history (adjusted matched odds ratio (OR) = 4.87; 95 percent confidence interval (CI): 2.40–9.89; P<0.001). Vaccinated HZ cases experienced significantly more lateralization to the left side (χ2 = 12.146, P = 0.000). Conclusions: Vaccination with COVID-19 had significant statistical association with varicella zoster activation. Future studies may contemplate to verify the observed results.
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are the most common healthcare-associated infections, with rates varying between countries. Antimicrobial resistance (AMR) among common HAP/VAP pathogens has been reported, and multidrug resistance (MDR) is of further concern across Middle Eastern countries. This narrative review summarizes the incidence and pathogens associated with HAP/VAP in hospitals across Gulf Cooperation Council (GCC) countries. A PubMed literature search was limited to available data on HAP or VAP in patients of any age published within the past 10 years. Reviews, non-English language articles, and studies not reporting HAP/VAP data specific to a GCC country were excluded. Overall, 41 articles, a majority of which focused on VAP, were selected for inclusion after full-text screening. Studies conducted over multiple years showed a general reduction in VAP rates over time, with Gram-negative bacteria the most commonly reported pathogens. Gram-negative isolates reported across GCC countries included Acinetobacter baumannii , Pseudomonas aeruginosa , and Klebsiella pneumoniae . Rates of AMR varied widely among studies, and MDR among A. baumannii , K. pneumoniae , Escherichia coli , P. aeruginosa , and Staphylococcus aureus isolates was commonly reported. In Saudi Arabia, between 2015 and 2019, rates of carbapenem resistance among Gram-negative bacteria were 19–25%; another study (2004–2009) reported antimicrobial resistance rates in Acinetobacter species (60–89%), P. aeruginosa (13–31%), and Klebsiella species (100% ampicillin, 0–13% other antimicrobials). Although limited genotype data were reported, OXA-48 was found in ≥ 68% of patients in Saudi Arabia with carbapenem-resistant Enterobacteriaceae infections. Ventilator utilization ratios varied across studies, with rates up to 0.9 reported in patients admitted to adult medical/surgical intensive care units in both Kuwait and Saudi Arabia. VAP remains a burden across GCC countries albeit with decreases in rates over time. Evaluation of prevention and treatment measures and implementation of a surveillance program could be useful for the management of HAP and VAP.
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