Background: Adults with cardiopulmonary conditions are at increased risk for complications from influenza and respiratory syncytial virus (RSV) infection, but few data are available from middle-income countries. Methods: Using data from a prospective cohort study of influenza vaccine effectiveness among community-dwelling Thai adults aged ≥65 years, we estimated and compared the incidence of influenza and RSV in those with and without cardiopulmonary conditions. During May 2015-May 2017, older adults in a rural province in Thailand were followed weekly with year-round surveillance for acute respiratory illness (ARI), defined broadly as new onset or worsening of cough with or without fever, and hospitalized ARI. When ill, nasal self-swabs and/or nasopharyngeal swabs were collected for reverse-transcription polymerase chain reaction testing. We used Poisson regression to calculate incidence rate ratios (IRR), adjusting for age, sex, past healthcare-seeking behavior, weekly influenza activity, and influenza vaccination. Results: Overall, 3,220 adults with a median age of 71 years (IQR 68-76) were enrolled; 1,324 (41.1%) were male; and 313 (9.7%) had ≥1 underlying cardio-pulmonary condition, most commonly chronic obstructive pulmonary disease (131; 41.2%) or asthma (73; 23.3%). Compared to those without, participants with cardiopulmonary conditions had higher incidences of ARI, influenza, and RSV (Adjusted IRR: 1.83, 95% CI 1.63-2.05; 1.84, 95% CI 1.05-3.23; 2.02, 95% CI 1.10-3.72, respectively). Conclusion: Our findings show that older adults in rural Thailand with cardiopulmonary conditions have increased rates of ARI, influenza, and RSV infections, and support efforts to ensure this population has access to influenza vaccines and other respiratory illness prevention measures.

Jorge. A. Kurczyn1 , Rodrigo Duran2,3, Emilio Beier4 , and Alejandro J. Souza5 1Cátedras CONACyT-Instituto Epomex, now at Laboratorio de Ingeniería y Procesos Costeros, Instituto de Ingeniería, Universidad Nacional Autónoma de México, Sisal, Yucatán 97356, México2 National Energy Technology Laboratory Support Contractor, Albany, OR 97321, USA3 Thesis Research, San Diego, CA 92037, USA4Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE), Unidad La Paz, Laboratorio de Macroecología Marina, La Paz, Baja California Sur 23050, México5Centro de Investigación y Estudios Avanzados del Instituto Politecnico Nacional (CINVESTAV), Km 6 antigua Carr. Mérida - Progreso, Mérida, Yucatán 97310, México Corresponding author: J.A. Kurczyn (jkurczynr@iingen.unam.mx) Keywords: (1) Upwelling events (2) Shelf processes (3) In-situ observations (4) Climatological Lagrangian Coherent Structures

COVID-19-associated acute motor axonal neuropathy, a variant of Guillain-Barré Syndrome: Expanding the neurological manifestations of SARS-CoV-2

Objective: Sleep disorders are common among children and have a negative impact on growth and development. Recently reports demonstrate a possible association with oral findings as well. The aim of this study was to evaluate the possible association between sleeping habits, bruxism, temporomandibular disorders (TMD), traumatic dental injuries (TDI) and dental caries in children. Material and Methods: A cross-sectional study was carried out at IAU Faculty of Dentistry with a representative sample of a hundred children aged between 6-13. Children’s Sleep Habits Questionnaire (CSHQ) was completed by their parents. Intra oral examination was carried out in a clinical setting and presence of nocturnal bruxism, history of TDI were recorded for each child. Results: Among sleeping habits, bed time resistance was found significantly related with children who had nocturnal bruxism and temporomandibular disorders. Untreated dental caries was also found significantly associated with sleep fragmentation. However, no relation was found with traumatic dental injuries. Conclusion: Children with symptoms of bruxism, TMD and untreated dental caries might experience negative impacts on their sleeping habits and characteristics. Pediatricians and pedodontists should work in collaboration to identify causes and clinical features of sleeping habits and disorders in order to avoid negative effects on stomatognathic system.

Introduction: Following the Covid-19 pandemic, the face-to-face meetings are delayed to a future date , which is still not clear. However, seminars, meetings, and conferences are necessary for updating our knowledge and skills. The web-based seminars (webinars) are the solutions to this issue. This study aimed to show the participant behavior when webinars present at the Covid-19 pandemic era. Methods: Between December 2017 – July 2020, 58 webinars were broadcasted via the Uropedia, electronic library of SUST. Data of all webinars were collected with the YouTube analytics and application of the Uropedia. Data of streaming webinars included participant behaviors such as content views, engagement time, total unique attendees, average engagement time, and the number of audience to leads. Data were split into two groups; group-1 is webinars before Covid-19 (before March 2020), group-2 is the webinars during Covid-19. Results: Total broadcast time and total page view number were found to be 112.6 hours (6761 min.) and 15919, respectively. The median participant age was 40.1 years. Median content view and median engagement time were found to be 261.0 min., and 12.2 min., respectively. Comparison of two groups revealed a significant increment in the content views (group 1;134.0 range=86.0-87.0 and group 2; 414.0 range=296.0-602.0, p<0.001) and the number of the unique attendees (group 1; 18.0 range=10.0-26.0 and group 2; 57.0 range=27.0-100.0, p<0.001) following Covid-19. However, the median engagement time of the audience did not seem to change with the Covid-19 pandemic (group 1; 11.5 range=10.0-13.3 min. and group 2; 13.2 range=9.4-18.1 min., p=0.12). Conclusion: The webinars are effective ways to share information and have many advantages, including low cost, reaching the high number of audiences. Audience number and page visits seemed to increase following the Covid-19 pandemic. However, The engagement time did not seem to affect a critical attitude of the audience

Backgrounds Appendectomy is one of the most commonly performed surgeries worldwide. Sepsis is an major etiology of morbidity and mortality in children. Our preliminary research revealed a positive correlation among appendectomy and future risk of sepsis in adults. However, to date, the relationship among appendectomy and future risk of sepsis in children remains unknown. The aim of this research was to investigate the relationship among appendectomy and hazard of future sepsis in children. Methods We applied a nationwide population-based cohort to assess whether children who received appendectomy were at increased risk of subsequent sepsis. Overall, 57261 subjects aged below 18 undergoing appendectomy as appendectomy group and 57261 matched controls were identified as non-appendectomy group from the National Health Insurance Research Database in Taiwan. We use propensity score analysis to match age, sex, urbanization level, and parental occupation at the ratio to 1:1. Multiple Cox regression and stratified analyses were used to appraise the adjusted hazard ratio (aHR) for developing sepsis in children. Results Children who received appendectomy had a 2.63 times higher risk of developing sepsis than those who did not, and the risk was even higher in children aged under 6 years. Patients with <1 year follow-up showed a 5.64-fold risk of sepsis in the appendectomy cohort. Patients with 1–4 and ≥5 years’ follow-up showed a 2.41- and 2.02-times risk of sepsis. Conclusion Appendectomy was correlative to a 2.63-fold increased future sepsis risk in children, and the risk in younger patients aged <6 years was even higher. More studies to interpret the possible biological mechanisms of the associations among sepsis and appendectomy are warrant

Objective: In this study, the effect of tracheal diverticula (TD) on chest anthropometry and its relation with chronic obstructive pulmonary disease (COPD) was evaluated. Method: Between January 2019 and March 2020, 995 patients who underwent chest CT were retrospectively analyzed and TD was detected in 31 cases. Group 1 is only TD, Group 2 is TD + COPD, Group 3 is only COPD, Group 4 is defined as control group. We measured the localization, size, the distance to carina and vocal cord of TDs. In all groups chest diameters at T4 and T9 levels were measured as transverse and vertical plans. Results: TDs detected mostly at the T2 and T3 levels. In Group 1 and Group 2, there was a statistically significant difference the distance to TD of vocal chords. A statistically significant difference was found between Group 1 and Group 3 only in the vertical diameter at the T4 and T9 levels. Conclusion: We observed that COPD effect TD location and also TD had opposite effect on anteroposteriorly increasing chest parameters in COPD. Precence of TD is essential on COPD patients about thorax anthropometry. Keywords: Tracheal diverticulum; antropometry; radiology; COPD; chest diameter

Background: The aim of this study was to determine the predictive risk factors for development of severe bronchiolitis in patients with acute bronchiolitis with no previous chronic disease. Methods: Four hundred forty children aged 1-24 months hospitalized with acute bronchiolitis, were examined between February 2018 and February 2019 in this prospective study. Results: Eighty-five cases were regarded as severe bronchiolitis and 355 as mild-moderate bronchiolitis. Statistically significant differences were observed between the severe and mild-moderate bronchiolitis groups in terms of weight-for-age z-scores, history of bronchiolitis, hemoglobin levels, and time elapsed between onset of symptoms and admission. Weight-for-age z-scores, the mean time interval between onset of symptoms and admission, and mean hemoglobin values were lower in the severe bronchiolitis group while the mean number of bronchiolitis attacks was higher than in the mild-moderate bronchiolitis group. Logistic regression analysis determined that a low weight-for-age z-score increased the risk of severe bronchiolitis development 0.56-fold (CI: 0.409 – 0.760), a short duration between the onset of symptoms and admission increased the risk 0.62-fold (CI: 0.519 – 0.735), a frequent history of bronchiolitis increased the risk 1.81-fold (CI: 1.135 – 2.968) and low hemoglobin levels increased the risk 0.72-fold (CI: 0.537 – 0.969). Conclusion: Low weight-for-age z-scores, a short duration between the onset of symptoms and admission, a high number of previous attacks, and low hemoglobin levels were identified as independent parameters of severe bronchiolitis development. Key words: Bronchiolitis, Infant, Risk factors, Severity degree

Background: The prevalence of hypertensive disorder in pregnancy has been well-documented worldwide. In Chinese newborns, the risk of hypospadias in women with hypertension during pregnancy remains ambiguous. This study aimed to evaluate the relationship between hypertension in pregnancy and neonatal hypospadias based on a large sample of Chinese people. Methods: A retrospective cohort study was conducted at our hospital from 2015 to 2019. Mothers who delivered male infants with hypospadias or those without any malformations were enrolled. Factors such as hypertension, placenta previa, thyroid diseases, hepatitis B, obesity, multiple birth, amniotic fluid, gestational age, birth weight, and in vitro fertilization were collected to establish a regression analysis to assess risk factors for hypospadias. Results: In total, 41,490 mothers and 42,244 male infants were enrolled. The overall incidence of hypospadias was 0.23%. The occurrence rate of hypospadias in pregnancy-induced hypertension (PIH) group was higher than control group (0.944% vs. 0.186%, RR 5.08), whereas the occurrence rate in chronic hypertension group was 0%. Potential exposure factors were screened for hypospadias, and PIH, multiple birth, hyperthyroidism, preterm delivery, low birth weight, and small for gestational age (SGA) were found to have higher proportion of hypospadias in offspring. After adjustment for potential confounders in the multivariate regression analysis, PIH (OR: 2.437, 95% CI: 1.478–4.016, P<0.01), birth weight (OR: 0.852, 95% CI: 0.795–0.912, P<0.01), and SGA (OR: 3.282, 95% CI: 1.644–6.549, P<0.01) showed a significant relationship with hypospadias. Conclusion: Women with PIH had higher risks of hypospadias in offspring. Lower birth weight, SGA and hyperthyroidism were also statistically associated with hypospadias.

Purpose: To evaluate the bowel habits of patients with acne vulgaris Method: In this case control study, socio-demographic characteristics of the participants (age, gender, marital status, educational status, profession, economic status, smoking-alcohol habits, chronic diseases, previous operations, people they live with, diet) were questioned and the global acne grading scores of the patients were calculated. Bristol Stool Scale, Rome III Criteria for IBS, International Physical Activity Questionnaire-Short Form, Hospital Anxiety Depression and KADF (dietary fiber information) scales fulfilled. Results: The patient group consisted 102 and the control group consisted 104 participants. The mean age was 20.9 ± 3.9 years old in the case group and 21.8 ± 5.0 years old in the control group. Patient and control groups were similar in terms of age and gender. Smoking rates were significantly higher in the patient group (p=0,035). The amount of coffee consumed per day were significantly higher in the patient group (p=0,040). According to the global acne grading scores, 55.9% (n = 57) had medium, 39.2% (n = 40) had mild, 3.9% (n = 4) had severe and 1% (n=1) had very severe acne. Anxiety scores were found to be significantly higher in the patient group (p = 0.005). When the case and control groups were compared for IBS presence, no significant difference was found (p = 0.317). Also, IBS was not related with acne severity (p = 0.162). Conclusion: Further large sample sized studies are needed on this subject, as there is strong evidence about brain–gut–skin axis existence.

Background: Bruxism is significantly associated with craniofacial pain, feeling of stiffness or fatigue of the jaw and neck pain. Various physiotherapeutic strategies are used in the treatment of bruxism, however, it is not clear which method leads to greater decrease in pain. Objective: The aim of this study is to compare the effects of two physiotherapy methods (manual therapy (MT) and Kinesio taping with manual therapy (KTMT)) in patients with bruxism. Methods: Patients were randomized into MT or KTMT groups. Evaluations were performed at baseline and following four weeks of physiotherapy. Muscle thickness and stiffness were assessed via shearwave ultrasonography; pain thresholds were evaluated using algometer. Sleep quality was assessed using Pittsburgh Sleep Quality Index and Quality of life was assessed with Likert scales regarding the associated symptoms. Results: Significant improvements were found in muscle stiffness, pain threshold, sleep quality, quality of life (p<0.05) in both MT and KTMT group. Pain in bilateral temporalis and right occipital region of the trapezius muscle decreased more in the KTMT group compared to the MT group (p<0.05). No significant differences in muscle thickness (p>0.05) were found in either of the groups. Conclusion: Both MT and KTMT methods were effective in the treatment of bruxism. KT used in conjunction with MT has additionally decreased jaw pain and temporal region pain when compared to MT intervention only. Therefore, if jaw pain is the primary complaint of a patient, our results recommend including KT application in the physiotherapeutic treatment program.

Objective: Prediction of mortality in the patient of the intensive care unit is essential. It was aimed to study the mortality predictive value of mean platelet volume (MPV) in patients with severe head trauma. Study design: The mean platelet volumes were measured in patients with head injury managed intensive care unit between 1 December 2017 and 1 January 2019 at admission and exitus date. Methods: The main outcome variable was mortality due to the traumatic event of patients. 43 patients with head trauma admitted to the intensive care unit during the study period. 17 patients died (Group I), 26 survived (Group II). Results: There was not an association between MPV and mortality at admission. However, Cox regression analysis showed that late MPV (at exitus or discharged date), WBC at admission, and age increase the mortality rate 1,770, 1,202, 1,052 times, respectively. Conclusion: The present study shows that MPV may be a useful predictor of mortality in the patient with severe head trauma. More detailed studies are needed.

Megalocytivirus is a genus of piscine viruses that belongs to the Iridoviridae family, and this family comprises red seabream iridovirus (RSIV), turbot reddish body iridovirus (TRBIV), and infectious spleen and kidney necrosis virus. RSIV causes high mortality and economic losses in the rock bream (Oplegnathus fasciatus) Korean aquaculture industry. The World Organization for Animal Health’s Office International des Epizooties has provided a manual for RSIV detection. However, detection against TRBIV has not been confirmed. In this study, a multiplex PCR method was established to detect two genotypes of Megalocytivirus, RSIV and TRBIV. New primer pairs were optimized for the PCR reaction. A mixture of one universal and two specific primer pairs could amplify three distinct products targeting three different genes. The sensitivity of the primer pairs was evaluated and results showed a detection limit of 2.0  105 copies for each target gene. Moreover, the primer pairs did not amplify any other viruses. The evaluation of multiplex PCR using 21 RSIV Korean isolates has shown that it can distinguish two genotypes of Megalocytivirus from 21 RSIV Korean isolates. Finally, we describe a new multiplex PCR method to detect different genotypes of Megalocytivirus simultaneously, which makes the diagnosis of viral diseases occurring in the Korean aquaculture industry more convenient.

Background: The pandemic of the new coronavirus disease (COVID-19) continues to be a major health problem globally. In this study, clinical findings, radiological findings, laboratory findings and polymerase chain reaction (PCR) test results were evaluated according to age groups in pediatric patients with COVID-19. Methods: In this study, PCR (+) and PCR (-) 278 cases diagnosed with COVID-19 between March 15, 2020 and September 30, 2020 were assessed considering clinical symptoms, radiological and laboratory findings and RT-PCR test results. Results: 43.9% of the cases consisted of RT-PCR (+) and 56.1% of RT-PCR (-) cases. Fever was observed at the rate of 64.7%, cough 53.2%, respiratory distress 12.2%, myalgia 24.5%, diarrhea 12.9%, chest X-ray findings 48.2% and computed tomography findings 43.6%. Diarrhea and cough, alanine aminotransferase, aspartate aminotransferase, leukocyte and lymphocyte elevation were determined as significantly higher in younger age group cases, while high myalgia and neutrophilia was observed in older age group children (p <0.05). Fever, high CRP, leukocytosis frequency, high neutrophil, were significantly higher in PCR(-) cases and the frequency of respiratory distress, high lymphocyte and chest computed tomography findings in PCR(+) cases (p <0.05). Conclusion: COVID-19 infection may indicate different nonspecific clinical, laboratory and radiological findings in children according to both adults and pediatric age groups. In addition, the results of the PCR test may give erroneous results in cases due to conditions such as fever, respiratory distress, high CRP, leukocytosis, high neutrophil and CT finding. Keywords: pediatric, COVID-19, RT-PCR

Aims of the study: To test the feasibility of a group psychosocial intervention called Learning Through Play (LTP) plus Culturally adapted Cognitive Behaviour Therapy (CaCBT) for depressed Kenyan mothers with children aged 0-36 months. Methods used to conduct the study: This study was a single-arm mixed methods feasibility study to test an integrated parenting intervention for maternal depression in a low-income rural area of Fumbini village in Kilifi District of Kenya. Women between the ages of 18 and 45 years with children up to three years were screened for depression using PHQ-9 (Patient Health Questionnaire). Those scoring above 10 on PHQ-9 were interviewed using the Revised Clinical Interview Schedule (CIS-R) to confirm the diagnosis of depression. Assessments were carried out at baseline and the end of the intervention (3 months), followed by qualitative interviews with 12 women. Qualitative interviews were analysed using thematic analysis from a social-constructionist theoretical lens. Results of the study: The LTP Plus was both feasible and acceptable with high satisfaction among the participants. Qualitative results showed that the women perceived the intervention as beneficial in reducing the symptoms of depression, coping with stress and negative emotions. The results also indicated that there was a reduction in scores on PHQ-9, GAD-7 with an increase in perceived social support, health-related quality of life and an improvement in mothers’ knowledge about child development at the end of the intervention. Conclusions drawn from the study and clinical implications: This study represents the first feasibility research on integrated parenting intervention in Kenya. The results indicated that culturally adapted LTP plus CaCBT is feasible and acceptable in a low-income setting of Kenya. There is now a need to study the clinical and cost-effectiveness of LTP plus CaCBT in an appropriately powered larger randomised control trial, with a longer follow-up period.

Objective: There is lack of evidence on the burden of and factors associated with non-adherence to anti-diabetic medication among individuals living with diabetes in low-and middle-income countries (LMICs). Therefore, we carried out a systematic literature review and meta-analytic synthesis to estimate non-adherence to anti-diabetic medication reported among adults in LMICs and to explore factors affecting non-adherence. Methods: We systematically searched MEDLINE and Embase to identify studies investigating non-adherence to anti-diabetic medications published between January 2000 and May 2020. Cross-sectional studies that had been conducted among individuals with diabetes in LMICs were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Meta-analysis was carried out using Stata 14.2. Random effects model was used to compute the pooled proportion at 95% confidence interval. Results: Forty-three studies met the inclusion criteria, of which 13 studies were used in meta-analysis. The pooled proportion of non-adherence to anti-diabetic medications using the eight-item Morisky Medication Adherence Scale (MMAS) was 43.4% (95% CI: 17.5–69.4; p=0.000) and 29.1% (95% CI: 19.8–38.4; p=0.000) when using the cut-off at 80 or 90%. The pooled proportion of non-adherence was 29.5% (95% CI: 25.5–33.5; p=0.098) when using the four-item Morisky Medication Adherence Scale. The factors for non-adherence based on World Health Organization demonstrated considerable variation of non-adherence to ant-diabetic medication in LMICs depending on the methods used to estimate non-adherence. Conclusions: These findings demonstrate a significantly higher proportion of medication non-adherence among individuals with diabetes in LMIC settings when MMAS-8 item scale was used and low when 80-90% cut-off scales were used. Various factors, such as disease factors, therapy-related factors, healthcare system factor, patient-centered factors, and social and economic factors contributed to non-adherence. Therefore, comprehensive multifaceted strategies are urgently needed to address factors associated with anti-diabetic medication non-adherence.

Introduction: Trauma is the most common cause of death in childhood. Tissue damage, ischemia-reperfusion injury and inflammatory response are mainly responsible for increasing serbest oxiygen radicals. In this study, we aimed to investigate the use of thiol-disulfide and ischemia-modified albumin levels as a diagnostic laboratory parameter in trauma children. Method: Of 202 children, 101 of them were hospitalized in pediatric surgical intensive care unit with trauma and 101 of others were healthy children. Levels of native thiol (-SH), total thiol (SH + SS), dynamic disulfide (SS), dynamic disulfide (SS) / total thiol (SH + SS), albumin and ischemic modified albumin (IMA) were measured from the sera of patients and healthy volunteers. For statistical analyses, SPSS 17.0 was used. Mann-Whitney U and paired correlation test were used where appropriate. p <0.05 was considered significant. Results: The mean age of the patients in the trauma group (Boys: 61 Girls: 40) was 7,88 years and the control group was 8,00 years. In trauma group, 86 of children were exposed to blunt trauma, 15 of children had penetrating trauma and 54 patients had multiple trauma. Surgical procedures were performed in 17 patients. In the trauma group, native thiol, total thiol, dynamic disulfide / total thiol, albumin and IMA levels were significantly lower than that of control (p <0.001) and their dynamic disulfide (p = 0.001) was higher compared to the control. There was no difference thiol-disulfide parametres in trauma groups sub-division as surgery(n=17) vs. follow-up(n=84) groups or multiple trauma(n=54) vs. isolated organ trauma(n=47) groups, or penetrating(n=15) or blunt trauma(n=86) groups. Conclusion: Thiol-disulfide balance and IMA levels show changes in favor of oxidative stress in children with trauma, however, it cannot be used as a laboratory marker that helps to show the system and organ affected by the trauma and to decide the surgical intervention.

Background: Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to use of free flaps. Method: In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single center. Results: Reconstructions were performed with secondary healing (n=2), negative pressure wound therapy and skin grafting (n=2), free flaps (n=6), and local and distant flaps (n=4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. Conclusion: Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. Use of special digital imaging techniques facilitates flap surgery and helps minimize the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Superthin free flaps offer a distinct advantage in skillful hands. Use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favorable outcomes.

Background. Effective communication regarding the use of medications in a hospital environment is a process that contributes to the promotion of patient safety. Despite its importance, especially for medication reconciliation, written communication about the use of medications in medical records remains insufficiently investigated. Aim. To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and on hospital discharge.Method. A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalized for at least 48 hours. The clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a developed questionnaire and aimed at gathering the use of medications prior to hospital admission, changes in the prescribed medications in hospital stay and discharge, as well as prescription non-conformities. Non-conformities were considered as any irregularities reported by the healthcare team involving the medication use process. Communication failures between the three healthcare professionals were also analyzed and classified. Results. This study included 202 patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 8 (22.9%) of pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, but only 390 (24.5%) of these changes were justified. Conclusion. Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in the pharmacists’ documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.

A document by Ahmad Sharara. Click on the document to view its contents.

Abstract: Background: The 2019 coronavirus disease (COVID-19) pandemic is a public health emergency and constitutes a challenge to psychological health. This study aimed to assess the psychological conditions among university students in Saudi Arabia during the COVID-19 pandemic. Material and Methods: During the period between the 4th and 18th of June 2020, the students at Umm AlQura University in Saudi Arabia were invited to complete an online survey. The survey assessed their sociodemographic characteristics, educational disciplines, and manifestations of depression, anxiety, and stress as determined by the Depression Anxiety Stress Scale-21 (DASS-21). Results: The study included 936 students. Of them, 41.1% had depressive symptoms (31.7% mild to moderate and 9.4% severe to very severe), 26.9% had anxiety symptoms (15.8% mild to moderate and 11.1% severe to very severe), and 22.4% had stress symptoms (15.2% mild to moderate and 7.2% severe to very severe). Students who reported having a friend or relative infected with or died from COVID-19, watching or reading news about the pandemic ≥2 hours/day, and not having emotional support from family, university, and society were more likely to show psychological problems. Conclusion: Symptoms of depression, anxiety, and stress were common among Saudi university students. Psychological counseling and support should be provided to university students in Saudi Arabia. Keywords: Depression; Anxiety; Stress; COVID-19; University students; Saudi Arabia

Abstract Children aged 2-12 years scheduled to receive moderately or highly emetogenic chemotherapy were randomly assigned to arm-A (fosaprepitant) or arm-B (aprepitant). Children recruited to arm-A received intravenous ondansetron plus dexamethasone followed by fosaprepitant infusion. Children recruited to arm-B received the same drugs as those given to children in arm-A, except that fosaprepitant was substituted with aprepitant. The primary end point of the study was to determine the proportion of patients who achieved a CR, defined as no vomiting, no retching, and no use of rescue medication, the proportion of patients who achieved a CR during the acute phase (0-24 hours) after administration of the last dose of chemotherapy. Secondary end points were the proportion of patients who achieved a CR during the 24-120 hours (delayed phase) and overall after administration of the last dose of chemotherapy. Results: One hundred and eight patients were analyzed (55 in the fosaprepitant arm and 53 in the aprepitant arm). CR rates were higher in the fosaprepitant arm compared with the aprepitant arm during the acute phase (95 % vs 79 %, P =0.01< 0.05), delayed phase (71 % vs 66 %, P =0.89 ), and overall phase (69 % vs 57 %, P =0.18). Furthermore, the demand of rescue anti-emetics observed in fosaprepitant arm (7 %) has no difference with aprepitant arm (11 %). Conclusion: Addition of fosaprepitant to ondansetron and dexamethasone is more effective than aprepitant for the prevention of acute vomiting.

Background: Contrast computed tomography (CT) is a useful tool for the detection of intracardiac thrombi. We aimed to assess the accuracy of the late-phase prone-position contrast CT (late-pCT) for thrombus detection in patients with persistent or long-standing persistent atrial fibrillation (AF). Methods: Early and late-phase pCT were performed in 300 patients with persistent or long-standing AF. If late-pCT did not show an intracardiac contrast defect (CD), catheter ablation (CA) was performed. Immediately prior to CA, intracardiac echocardiography (ICE) from the left atrium was performed to confirm thrombus absence and the estimation of the blood velocity of the left atrial appendage (LAA). For patients with CDs on late-pCT, CA performance was delayed, and late-pCT was performed again after several months following oral anticoagulant alterations or dosage increases. Results: Of the 40 patients who exhibited CDs in the early phase of pCT, six showed persistent CDs on late-pCT. In the remaining 294 patients without CDs on late-pCT, the absence of a thrombus was confirmed by ICE during CA. In all six patients with CD-positivity on late-pCT, the CDs vanished under the same CT conditions after subsequent anticoagulation therapy, and CA was successfully performed. Furthermore, the presence of residual contrast medium in the LAA on late-pCT suggested a decreased blood velocity in the LAA (≤ 15 cm/s) (sensitivity = 0.900 and specificity = 0.621). Conclusions: Late-pCT is a valuable tool for the assessment of intracardiac thrombi and LAA dysfunction in patients with persistent or long-standing persistent AF before CA.

Background: Atrial Fibrillation (AF) is present in over 6 million Americans. However, AF occurs less commonly in African Americans and Latinos compared to Caucasians. Major adverse cardiovascular events (MACE) is the leading cause of death in these populations. Hypothesis: We theorize that glomerular filtration rates (GFR) is an independent risk factor for MACE in African Americans and Latinos with non-valvular AF (NVAF). Methods: The association of reduced GFR with MACE in NVAF patients was investigated by retrospective chart review. 656 patients were included: 339 with GFR <60 and 317 with GFR ≥60. A Chi-square test, two-sample t-test, or Wilcoxon Rank Sum test was used to test for differences between the two groups in terms of demographic variables and other risk factors. The association between GFR groups and myocardial infarction (MI), stroke, and/or death, was tested using binomial logistic regression. To incorporate the element of time and adjust for covariates, a Cox proportional hazards model analysis was applied for each outcome variable. Results: As compared to GFR ≥60, a GFR <60 in NVAF was an independent risk factor for MI (HR 1.88 (1.17, 3.04); p=0.009); death (HR 1.63 (1.11, 2.41); p=0.014) and MI, stroke or death ((HR 1.37 (1.05, 1.78); p=0.018). GFR <60 was not an independent risk factor for stroke (HR 1.13 (0.77, 1.65); p=0.529) Conclusion: Renal dysfunction in patients with NVAF is an independent risk factor for MI, death in and composite of MI, stroke and death in African American and Latino populations.