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Afnan J Alshrefy,1 Rawaa N Alwohaibi,1 Shahad A Alhazzaa,1 Reema A Almaimoni,1 Latifah I AlMusailet,1 Shaya Y AlQahtani,2 Mohammed S Alshahrani3 1College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Eastern Province, Saudi Arabia; 2Department of Internal Medicine and Critical Care Medicine, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Khobar, Eastern Province, Saudi Arabia; 3Emergency and Critical Care Departments, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Khobar, Eastern Province, Saudi ArabiaCorrespondence: Mohammed S Alshahrani, Emergency and Critical Care Departments, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Khobar, Eastern Province, 34219, Saudi Arabia, Tel +966556966663, Fax +966138966770, Email Msshahrani@iau.edu.saPurpose: Secondary infections have been observed among coronavirus disease 2019 (COVID-19) patients, especially in the intensive care unit (ICU) setting, which is associated with worse clinical outcomes. The current study aimed to investigate the incidence, common pathogens, and outcome of bacterial and fungal secondary infections among ICU patients with COVID-19.Methods: A retrospective chart review of all patients admitted to the ICU at King Fahd Hospital of the University in Saudi Arabia. All adult patients aged ≥ 18 admitted in the ICU for ≥ 48 hours with positive COVID-19 reverse transcription-polymerase chain reaction test during the period between March 2020 till September 2021 were included.Results: Out of 314 critically ill patients, 133 (42.4%) developed secondary infections. The incidence of secondary bacterial infection was 32.5% with Pseudomonas aeruginosa (n = 34), Acinetobacter baumannii (n = 33), and Klebsiella pneumoniae (n = 17) being the predominant pathogens, while secondary fungal infection was 25.2% mainly caused by Candida albicans (n = 43). Invasive mechanical ventilation was significantly associated with the development of secondary bacterial infections (odds ratio [OR] = 17.702, 95% confidence interval [CI] 7.842– 39.961, p < 0.001) and secondary fungal infections (OR = 12.914, 95% CI 5.406– 30.849, p < 0.001). Mortality among patients with secondary infections was 69.2% (n = 92). Secondary infections were associated with longer hospital and ICU stays with a median of 25 days (interquartile range [IQR] 17– 42) and 19 days (IQR 13– 32), respectively.Conclusion: Bacterial and fungal secondary infections are common among COVID-19 patients admitted to the ICU with a predominance of gram-negative bacteria and Candida species. The development of secondary infections was significantly associated with invasive mechanical ventilation. Poor clinical outcomes have been observed, demonstrated with a prolonged hospital and ICU stays and higher mortality.Keywords: COVID-19, intensive care unit, secondary infection, bacterial, fungal

Objectives: The study aimed to explore the spectrum and trend of causative microbial agents and to identify management challenges and the risk factors for poor outcomes in patients with confirmed otogenic skull base osteomyelitis., Methods: A retrospective observational study was conducted at a tertiary-care academic center from 1999 through 2019 and included 28 adult patients with confirmed otogenic skull base osteomyelitis. Relevant data was extracted from electronic and hard patient medical files. The microbial spectrum of involved microbes was identified and correlated to management options. Deterioration risk factors were investigated using suitable statistical analysis tests., Results: Twenty-eight patients with confirmed skull base osteomyelitis were included; most were males (78.6%) and Saudis (78.6%). All patients were ≥50 years of age (mean ± SD is 69.0±10.2.4). Of 41 identified microbial isolates, 56% were bacterial, 44% were fungal. 32.1% of patients had polymicrobial infections, most patients (92.8%) had received ≥2 systemic antibiotics, 57.1% received systemic antibiotic combinations, and 32.1% underwent surgical interventions. The mean antibiotic and antifungal therapy duration was 58.3 and 45.8 days, respectively. The identified risk factors of deterioration were advanced age and concomitant cardiac failure, with P-values of .006 and .034, respectively., Conclusions: The study findings highlight the microbiological spectrum and trend of otogenic skull base osteomyelitis-causative microbes over two decades, present the management challenges, identify deterioration risk factors, and suggest tissue biopsy as the golden standard for accurately identifying causative microbes., Competing Interests: Competing interests: There are no conflicts of competing interest to be disclosed regarding this paper.

Background and Aim: Video gaming has witnessed tremendous growth in recent years. Video games have been associated with various negative effects on players, such as aggressive behavior and reduced apathy. The present review aims to investigate the association between video games and violence among children and adolescents in the Arab world, while highlighting the influence of the type of video games played, time spent playing, and other possible associated factors., Methods: A literature search was performed on PubMed and Web of Science electronic databases. All studies assessing video games and violence among children and adolescents written in English were eligible for inclusion in the review. A total of 9 studies were included in this systematic review., Results: Six studies investigated the relationship between video games and aggression, five of which found a significant association. Several factors have been studied to assess their role in mediating the association between the two. A statistically significant association was found between aggression and age and sex of the players, with a predominance among early adolescents and males. Longer durations spent playing video games were found in three studies to be significantly associated with a greater risk of aggression., Conclusions: In the Arab world, studies addressing this subject are limited. The discrepancy of reported results between video games and amount of violence could be attributed to the lack of standardization across studies. Therefore, it becomes imperative to further explore the association through conclusive studies with standardized measures.(www.actabiomedica.it).