Risk factors for emergency surgery for diverticulitis: A retrospective multicentric French study at 41 hospitals.

BACKGROUND: The observed increase in the incidence of complicated diverticulitis may lead to the performance of more emergency surgeries. This study aimed to assess the rate and risk factors of emergency surgery for sigmoid diverticulitis. METHOD: The primary outcomes were the rate of emergency surgery for sigmoid diverticulitis and its associated risk factors. The urgent or elective nature of the surgical intervention was provided by the surgeon and in accordance with the indication for surgical treatment. A mixed logistic regression with a random intercept after multiple imputations by the chained equation was performed to consider the influence of missing data on the results. RESULTS: Between 2010 and 2021, 6,867 patients underwent surgery for sigmoid diverticulitis in the participating centers, of which one-third (n = 2317) were emergency cases. In multivariate regression analysis with multiple imputation by chained equation, increasing age, body mass index <18.5 kg/m2, neurologic and pulmonary comorbidities, use of anticoagulant drugs, immunocompromised status, and first attack of sigmoid diverticulitis were independent risk factors for emergency surgery. The likelihood of emergency surgery was significantly more frequent after national guidelines, which were implemented in 2017, only in patients with a history of sigmoid diverticulitis attacks. CONCLUSION: The present study highlights a high rate (33%) of emergency surgery for sigmoid diverticulitis in France, which was significantly associated with patient features and the first attack of diverticulitis.

Levels and Factors of Nurses' Alarm Fatigue in Critical Care Settings in Saudi Arabia: A Multicenter Cross-Sectional Study.

Background: A continuous and high frequency of alarms from monitoring and treatment devices can lead to nurses' sensory exhaustion and alarm fatigue in critical care settings. Aim: The purpose of this study was to evaluate the level of alarm fatigue and determine the relationship between nurses' sociodemographic and work-related factors and the level of alarm fatigue in critical care settings in Hail City, Saudi Arabia. Methods: Between May and July 2023, 298 nurses who worked in the emergency, intensive care, and critical care units of all the public hospitals in Hail City participated in a cross-sectional survey. Sociodemographic and work-related sheet and the Nurses' Alarm Fatigue Questionnaire were used to collect data. Results: The total mean score of alarm fatigue was 26.38±8.30 out of 44. The highest score was observed for the item "I pay more attention to the alarms in certain", while the lowest score were observed for the items "I turn off the alarms at the beginning of every shift" with mean scores of 2.51 and 1.61, respectively. Nurses who were males, older than 30 years and Saudi citizens had significantly higher mean scores of alarm fatigue than their counterparts. In addition, significantly higher mean scores of alarm fatigue were noticed for nurses experienced for 10 years or more and who had regular morning shifts. Multiple linear regression showed that male (p=0.014), age (p=0.012), and Saudi nationality (p <0.029) were the independent factors affecting the level of fatigue alarm among nurses. Conclusion: Nurses working in critical care settings at hospitals in Hail city are exposed to average levels of alarm fatigue, which can be influenced by sex, age, nationality, and experience of nurses. Therefore, it is imperative to manage alarm fatigue in critical care units by considering work-related and personality-related factors to ensure patient safety.

Healthcare workers' compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen.

BACKGROUND: Catheter-associated urinary tract infection is a global problem but it can be prevented with the appropriate implementation of evidence-based guidelines. This study was conducted to assess the level of compliance of healthcare workers with the catheter-associated urinary tract infection prevention guidelines during the insertion of a urinary catheter. METHODS: An observational study using a descriptive cross-sectional design was conducted at Sana'a City hospitals, Yemen. All the nurses and physicians from the governmental, teaching, and private hospitals were eligible to participate in the study. The data collection was performed through convenience sampling from March 2020 to December 2020, using a structured observational checklist prepared specifically for this study. RESULTS: The majority of the urinary catheter insertions were performed by nurses. There were no written policy or procedures for an urinary catheter insertion and no in-service education or training departments in the majority of the hospitals. The overall mean score of compliance was 7.31 of 10. About 71% of the healthcare workers had a high or acceptable level of compliance and 29% had an unsafe level of compliance. Compliance was low for maintaining aseptic technique throughout the insertion procedure, using a single use packet of lubricant jelly, performing hand hygiene immediately before insertion, and securing the urinary catheter once inserted. Factors affecting the healthcare workers compliance were gender, the working ward/unit of the healthcare workers, the availability of a written policy/procedure and a department or unit for in-service education. CONCLUSION: Yemeni healthcare workers' overall compliance was acceptable but it was unsafe in several critical measures. There is an urgent need for developing, implementing, and monitoring national guidelines and institutional policy and procedures for catheter-associated urinary tract infection prevention. Periodical in-service education and training programs and adequate access to the necessary materials and supplies are paramount.

Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study.

OBJECTIVE: To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19. METHODS: From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21). RESULTS: A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity. CONCLUSION: This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality.

Impact of resilience-based intervention on emotional regulation, grit and life satisfaction among female Egyptian and Saudi nursing students: A randomized controlled trial.

AIM: Evaluate and compare the impact of a resilience-based intervention on emotional regulation, grit and life satisfaction among female Egyptian and Saudi nursing students. BACKGROUND: Nursing students should experience a comprehensive learning environment since they are mind-body-spirit creatures. Therefore, nursing education should emphasize growing students' physical, social, emotional and spiritual well-being in addition to their knowledge, skills and attitudes. DESIGN: This study followed a parallel arm randomized controlled trial design. Study participants were randomly assigned to the intervention or control groups in a (1:1) ratio. It was conducted between January 2023 and the end of April 2023. METHOD: Students were randomly allocated to the eight-week resilience intervention (n= 60) or a control (n= 60) group (half of the students in each group were from each country). The intervention group received a pamphlet and attended eight weekly 15-person sessions on resilience, grit (perseverance), emotional regulation and self-care. The Emotion Regulation Questionnaire, the Short Grit Scale and the Satisfaction with Life Scales were administered pre- and immediately post-intervention. RESULTS: Between pre- and post-intervention, there were significant improvements in grit (from 41.374.27 to 51.235.22 among Egyptian students with an effect size of 0.663 and from 42.974.30 to 54.103.87 among Saudi students with an effect size of 0.800), as well as mean emotional regulation (from 36.635.11 to 55.707.51 among Egyptian students with an effect size of 0.818 and from 44.606.87 to 61. With a substantial effect size of 0.850 (p0.001), Egyptian nursing students experienced a more significant rise in mean life satisfaction than Saudi nursing students (18.336.54 to 29.305.14). CONCLUSION: Resilience-based interventions enhanced emotional regulation, grit and life satisfaction in Egyptian and Saudi female nursing students. Grit, resilience and emotional regulation should be incorporated into nurse training to equip female students with the necessary values and protective factors to succeed in their studies. Given the unique challenges and stressors that female nursing students may face, nursing programs and institutions must provide resources and support services to help students manage stress and build resilience.

Diabetes education self-management intervention in improving self-efficacy for people with type 2 diabetes in the Gulf Cooperation Council countries: A systematic review.

AIMS: This research aims to evaluate the effectiveness of diabetes education self-management intervention for improving self-efficacy for people with type 2 diabetes mellitus in the Gulf Cooperation Council countries. METHODS: The Joanna Briggs Institute's methodology was applied to conduct a systematic review of type 2 diabetes interventions published from 2012 to 2022. This involved searching major databases, including Ovid, CINAHL, Scopus, Web of Science, and PubMed, with specific inclusion and exclusion criteria. The focus was on studies involving adults aged 18 or older with a Type 2 Diabetes (T2D) diagnosis, randomized controlled trials, and full-text English-language articles, while excluding materials such as editorials and conference abstracts. RESULTS: A total of 689 relevant articles initially retrieved; ultimately, only five studies met the inclusion criteria of this review. All five included studies were randomised control trials, and all five studies indicated that there was a significant and positive impact of diabetes education self-management intervention on diet and physical activities. Furthermore, three of the included studies indicated that interventions led to a substantial reduction in the levels of glycosylated haemoglobin (HbA1c) among people with type 2 diabetes. CONCLUSIONS: Diabetes education is an effective way of improving the health outcomes of people with type 2 diabetes. Diabetes education self-management interventions significantly increase the self-efficacy of people with Type 2 Diabetes (T2D) by enabling them to effectively control their blood glucose levels. Therefore, this study recommended that the GCC countries need to implement education intervention programmes to help and support people with Type 2 Diabetes.

Nursing students' perceptions on community care and placement preference in Saudi Arabian universities: A multicenter cross-sectional study.

BACKGROUND: There is an increasing shortage of highly educated community nurses; only a small number of nursing students choose to work in the community. OBJECTIVES: To understand the perception among nursing students in Saudi Arabia about working in the community and where they intend to pursue their careers. DESIGN: A quantitative cross-sectional design. SETTINGS AND PARTICIPANTS: A convenience sample of undergraduate students enrolled in their first to final years of a bachelor's degree program at three Saudi Arabian universities. METHODS: Data were collected from September-December 2022 using the 'Scale on Community Care Perceptions', which included demographic questions and measures reflecting their impressions of a community care placement, a community care career, and their current placement preferences. RESULTS: In total, 439 students completed the online questionnaire. Nursing students' community care feelings (affective component), expectations, and regards as a future profession were moderately positive with a mean of 6.68 (1-10 scale; negative-positive perceptions). Regarding placement preference, many students chose general hospitals (N = 212, 48.30 %); a small number chose community care (N = 77, 17.54 %). The positive choice of respondents was influenced by the various technical nursing skills required (N = 212, 10.6 %), enjoyable relationships with patients (N = 211, 10.5 %), and many opportunities for advancement (N = 169, 8.4 %). Furthermore, students' placement preferences were significantly predicted by their expectations of placement and future professions in community care (F = 95.24, p < 0.01, R2 = 0.30). A significant difference was also found among their preferences in terms of the level of education and the experience of family and friends working in the community (p < 0.01). CONCLUSION: Community care is an undervalued career choice among nursing students in Saudi Arabia. To bolster nursing students to prefer this career path, nursing schools, in coordination with local authorities, must formulate and implement a clearly defined career development plan that allows them to fully immerse themselves in community care activities.

Perceptions of nursing students and faculty members towards academic integrity and professionalism in Saudi Arabia: A cross-sectional study.

BACKGROUND: Maintaining and nourishing academic integrity along with professionalism in nursing education is integral and imperative to the development of the nursing profession. However, evidence shows that academic dishonesty and incompetency exist and are raising problems among college students of all disciplines including nursing. To date, limited studies have been conducted in this area in Saudi Arabia. OBJECTIVES: To determine the perceptions of nursing students and faculty members towards academic integrity and professionalism. DESIGN: A cross-sectional design. SETTINGS AND PARTICIPANTS: A convenience sample of undergraduate students enrolled in government universities in Saudi Arabia, and their faculty members. METHODS: 342 Saudi nursing students and 113 nursing faculty members were surveyed with a valid and reliable questionnaire modified to the study setting. RESULTS: Findings revealed that the majority of nursing students and faculty members were aware of the nature of academic dishonesty and unprofessionalism. Less 40 % of students and teachers reported academic dishonesty and unprofessionalism as frequent. The majority of respondents in both groups revealed there were no existing policies in their colleges relevant to academic integrity/dishonesty. For those who reported the presence of a policy, the highest percentage of the respondents expressed just occasional implementation. There was no significant difference between the perceptions of students and faculty in all scenarios regarding academic integrity and professionalism. Lastly, the level of education and affiliated nursing college was associated with the respondents' perceptions. CONCLUSIONS: Nursing students and faculty members have considerable cognizance of the concept of academic integrity and professionalism. However, the occurrence of academic dishonesty and unprofessionalism was observed at both universities. The lack of established policies is a particular challenge for management. Hence, it is essential that educational institutions formulate clear academic policies that cultivate academic integrity, prevent academic dishonesty, and enhance the level of professionalism.

COVID-19: Factors Associated with the Psychological Distress, Fear and Resilient Coping Strategies among Community Members in Saudi Arabia.

(1) Background: COVID-19 caused the worst international public health crisis, accompanied by major global economic downturns and mass-scale job losses, which impacted the psychosocial wellbeing of the worldwide population, including Saudi Arabia. Evidence of the high-risk groups impacted by the pandemic has been non-existent in Saudi Arabia. Therefore, this study examined factors associated with psychosocial distress, fear of COVID-19 and coping strategies among the general population in Saudi Arabia. (2) Methods: A cross-sectional study was conducted in healthcare and community settings in the Saudi Arabia using an anonymous online questionnaire. The Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale (FCV-19S) and Brief Resilient Coping Scale (BRCS) were used to assess psychological distress, fear and coping strategies, respectively. Multivariate logistic regressions were used, and an Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CIs) was reported. (3) Results: Among 803 participants, 70% (n = 556) were females, and the median age was 27 years; 35% (n = 278) were frontline or essential service workers; and 24% (n = 195) reported comorbid conditions including mental health illness. Of the respondents, 175 (21.8%) and 207 (25.8%) reported high and very high psychological distress, respectively. Factors associated with moderate to high levels of psychological distress were: youth, females, non-Saudi nationals, those experiencing a change in employment or a negative financial impact, having comorbidities, and current smoking. A high level of fear was reported by 89 participants (11.1%), and this was associated with being ex-smokers (3.72, 1.14-12.14, 0.029) and changes in employment (3.42, 1.91-6.11, 0.000). A high resilience was reported by 115 participants (14.3%), and 333 participants (41.5%) had medium resilience. Financial impact and contact with known/suspected cases (1.63, 1.12-2.38, 0.011) were associated with low, medium, to high resilient coping. (4) Conclusions: People in Saudi Arabia were at a higher risk of psychosocial distress along with medium-high resilience during the COVID-19 pandemic, warranting urgent attention from healthcare providers and policymakers to provide specific mental health support strategies for their current wellbeing and to avoid a post-pandemic mental health crisis.

Testing the validity and reliability of the Arabic version of the Disaster Response Self-Efficacy Scale among Saudi nursing students.

AIM: The study tested the validity and reliability of the "Disaster Response Self-Efficacy Scale" Arabic version (DRSES-A) among Saudi nursing students. BACKGROUND: Disaster self-efficacy is one such factor of increasing interest. Little research has explored disaster response self-efficacy despite growing evidence on disaster response preparedness in Saudi Arabia. A systematic, standardized and valid instrument is needed to assess disaster self-efficacy in the Saudi context. The DRSES is one of the tools with excellent psychometric properties that can evaluate the nursing students' perceived self-efficacy in disaster preparation, mitigation and response. DESIGN: This investigation is a quantitative methodological design testing the validity and reliability of the DRSES-A. METHOD: In this study, 290 Saudi nursing students were surveyed from May to June 2021 in the three government universities in Saudi Arabia using the convenience sampling technique. The Disaster Response Self-Efficacy Scale underwent a linguistic adaptation following a forward-backward translation method. Construct validity was established using the principal component analysis to extract the components of DRSES-A. RESULT: The overall mean of the DRSES-A was 3.41 (SD = 0.75). The overall Cronbach alpha was 0.939. The subscales "Onsite rescue" and "Psychological nursing" had a similar alpha of 0.911, while "Role quality and adaptation" had a computed alpha of 0.878. The expert rated all item content validity index as 1 with an average score content validity index of 1. The principal component analysis supported a three-factor DRSES-A. CONCLUSION: The DRSES-A is a valid and reliable scale that can measure Arabic-speaking baccalaureate nursing students' self-reported disaster response self-efficacy.

Consumer Behaviour and Attitude towards the Purchase of Organic Products in Riobamba, Ecuador.

The development of organic agriculture has been promoted worldwide to improve the nutritional health of families, and Ecuador is no exception. The aim of this research was to identify the behaviour and attitudes of consumers toward the commercialization of organic products in the city of Riobamba. This will help us to understand in what situations the consumers access these foods, the producer position in relation to the market, and to know their attitude towards these products. The study used a quantitative approach, and is descriptive, incorporating the deductive method and a non-experimental design. The techniques used were a survey as a source of data collection, with a sample including 195 consumers. Linear regression was applied to test the hypotheses; this made it possible to identify those demographic and cultural factors that determine, to a lesser extent, consumer purchase behaviour in regard to organic products. The study determined that motivation, emotions, and feelings are significantly related to the consumer's attitude and purchase of organic products.

COVID-19: Factors associated with psychological distress, fear, and coping strategies among community members across 17 countries.

BACKGROUND: The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally. OBJECTIVES: We aimed to examine the extent and identify factors associated with psychological distress, fear of COVID-19 and coping. METHODS: We conducted a cross-sectional study across 17 countries during Jun-2020 to Jan-2021. Levels of psychological distress (Kessler Psychological Distress Scale), fear of COVID-19 (Fear of COVID-19 Scale), and coping (Brief Resilient Coping Scale) were assessed. RESULTS: A total of 8,559 people participated; mean age (±SD) was 33(±13) years, 64% were females and 40% self-identified as frontline workers. More than two-thirds (69%) experienced moderate-to-very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (1.56 [1.29-1.90]), comorbidity with mental health conditions (3.02 [1.20-7.60]) were associated with higher levels of psychological distress and fear. Doctors had higher psychological distress (1.43 [1.04-1.97]), but low levels of fear of COVID-19 (0.55 [0.41-0.76]); nurses had medium to high resilient coping (1.30 [1.03-1.65]). CONCLUSIONS: The extent of psychological distress, fear of COVID-19 and coping varied by country; however, we identified few higher risk groups who were more vulnerable than others. There is an urgent need to prioritise health and well-being of those people through well-designed intervention that may need to be tailored to meet country specific requirements.

Saudi Arabia's Healthy Food Strategy: Progress & Hurdles in the 2030 Road.

The Kingdom of Saudi Arabia (KSA) is a leading country worldwide in the prevalence of non-communicable diseases (NCDs), which alone can explain 73% of mortality in the country. In response to the heavy burden of NCDs, the Saudi Food and Drug Authority (SFDA), in collaboration with other government entities, developed a healthy food strategy (HFS) aimed at enhancing healthy lifestyles and reducing the intake of salt, sugar, saturated fatty acids (SSF) and trans fatty acids (TFA). The objectives of the HFS, to facilitate consumers' identification of SSF and reduce the SSF and TFA content in food items, were addressed in collaboration with key stakeholders in the public and private sectors of the food industry. These reforms included voluntary and mandatory schemes to display nutrition information in food and beverage establishments, display allergens on food menus, encourage the adoption of front of pack nutrient labels (FoPNLs) on food products, ban the use of partially hydrogenated oils and establish limits for sodium composition in breads and selected food products. This manuscript contextualizes the HFS and presents the results of monitoring initiatives undertaken by the SFDA to assess compliance with these reforms.

Knowledge, attitudes, anxiety, and preventive behaviours towards COVID-19 among health care providers in Yemen: an online cross-sectional survey.

BACKGROUND: The growing incidence of coronavirus (COVID-19) continues to cause fear, anxiety, and panic amongst the community, especially for healthcare providers (HCPs), as the most vulnerable group at risk of contracting this new SARS-CoV-2 infection. To protect and enhance the ability of HCPs to perform their role in responding to COVID-19, healthcare authorities must help to alleviate the level of stress and anxiety amongst HCPs and the community. This will improve the knowledge, attitude and practice towards COVID-19, especially for HCPs. In addition, authorities need to comply in treating this virus by implementing control measures and other precautions. This study explores the knowledge, attitude, anxiety, and preventive behaviours among Yemeni HCPs towards COVID-19. METHODS: A descriptive, web-based-cross-sectional study was conducted among 1231 Yemeni HCPs. The COVID-19 related questionnaire was designed using Google forms where the responses were coded and analysed using the Statistical Package for the Social Sciences software package (IBM SPSS), version 22.0. Descriptive statistics and Pearson's correlation coefficient test were also employed in this study. A p-value of < 0.05 with a 95% confidence interval was considered as statistically significant. The data collection phase commenced on 22nd April 2020, at 6 pm and finished on 26th April 2020 at 11 am. RESULTS: The results indicated that from the 1231 HCPs participating in this study, 61.6% were male, and 67% were aged between 20 and 30 years with a mean age of 29.29 ± 6.75. Most (86%) held a bachelor's degree or above having at least 10 years of work experience or less (88.1%). However, while 57.1% of the respondents obtained their information via social networks and news media, a further 60.0% had never attended lectures/discussions about COVID-19. The results further revealed that the majority of respondents had adequate knowledge, optimistic attitude, moderate level of anxiety, and high-performance in preventive behaviours, 69.8, 85.10%, 51.0 and 87.70%, respectively, towards COVID-19. CONCLUSION: Although the Yemeni HCPs exhibited an adequate level of knowledge, optimistic attitude, moderate level of anxiety, and high-performance in preventive behaviours toward COVID-19, the results highlighted gaps, particularly in their knowledge and attitude towards COVID-19.

Comparison between five CAD/CAM systems for fit of zirconia copings.

OBJECTIVE: The aim of this in-vitro study was to investigate the marginal and internal fit of zirconia copings fabricated by five CAD/CAM (computer-aided design/computer-assisted manufacture) systems. METHOD AND MATERIALS: A typodont mandibular right first molar was prepared according to ideal parameters for a zirconia crown, scanned digitally, and 100 identical resin dies fabricated by 3D printing. Samples were randomly divided into five groups and sent to CAD/CAM systems for zirconia copings (A, Ceramill-Motion 2, Amann Girrbach; B, Weiland, Ivoclar Vivadent; C, Cerec, Ivoclar Vivadent; D, Prettau Zirconia, Zirkonzahn; E, Cad4dent). CAD of the copings included standardized cement space of 30 µm and CAM was carried out. Copings were tried/adjusted on the respective dies and embedded under a standardized load of 20 N in self-curing resin. Samples were sectioned mesiodistally into two halves. Marginal and internal gap values were measured with a digital microscope at 50 to 200 × magnification at nine sites. RESULTS: The lowest and highest mean gap values of 46.93 ± 13.50 and 101.65 ± 35.56 µm were found for Group A and Group D, respectively. ANOVA showed a statistically significant difference between the mean values of all the groups (P = .000). Multiple comparisons with post hoc Tukey test indicated a statistically significant difference (P < .05) between: Group A and all groups except B; B with D; C with A; D with A; and B and E with A. Mean buccal/lingual gap value was found to be 51.54 ± 58.54 µm. Of the nine sites, the least gap resulted at the buccal axial wall and the greatest at the central groove. The overall mean gap recorded for the copings was 72.43 ± 57.56 µm. CONCLUSION: Marginal and internal adaptations of CAD/CAM zirconia copings is influenced by manufacturing technique, and variations exist for different systems. Measurement sites showed different levels. CAD/CAM systems investigated showed a clinically acceptable level of gap values (< 120 µm).

Evaluation of thickness of CAD/CAM fabricated zirconia cores by digital microscope.

Despite several advantages of digitalized workflow, researchers have noted discrepancies in the precision and trueness. This study investigated the accuracy in the final thickness of Zirconia (Zr) cores fabricated by five CAD/CAM systems. Standardized manufacturing of the cores with 1 mm thickness were carried out. Cores were then sectioned into two halves and measurement made with Digital Microscope at 5 points in micrometers. Overall, mean thickness for the groups was 1048.81 ± 94.01, which was 48 µm higher than the thickness programmed in the software. Anova showed a statistically significant difference between the groups (p= 0.000). Presence of variations in the thickness and 5 measurement points for the CAD/CAM systems investigated was found. No significant difference was observed and the thickness of the cores were within acceptable level.

A fatal case of propylthiouracil-induced ANCA-associated vasculitis resulting in rapidly progressive glomerulonephritis, acute hepatic failure, and cerebral angiitis.

INTRODUCTION: Propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis presenting with renal failure, acute hepatic failure, and cerebral angiitis is a rare yet fatal disease. Early diagnosis and management may help in reducing mortality and morbidity. Plasmapheresis and induction with either cyclophosphamide or rituximab is indicated. Understanding the pathophysiology and complex management of this disease poses challenges to clinicians. CASE REPORT: A 42-year-old woman presented with acute renal and hepatic failure. She had been on PTU for 11 months for Graves' disease. Initial urine microscopy showed red blood cell casts. Anti PR-3 antibodies were positive. Kidney biopsy revealed pauci-immune glomerulonephritis with crescent formation. Renal and hepatic failures were attributed to PTU-induced c-ANCA production as other serological workup was negative. Pulse steroids and plasmapheresis were initiated. Later she developed pneumonia. She was also given rituximab. After the first dose of rituximab, plasmapheresis was held for 3 days. The second dose of rituximab was given in 5 days owing to removal by plasmapheresis. She got 8 sessions of plasmapheresis. She also developed seizures and MRA of her head revealed cerebral infarct, with findings suggestive of cerebral angiitis. She did not recover and expired 20 days after presentation. CONCLUSION: PTU can cause ANCAassociated vasculitis resulting in multiorgan failure. Plasmapheresis should be held for 3 days after rituximab infusion in order to allow maximum exposure. The second dose of rituximab may be given before the recommended 7-day interval in cases in which plasmapheresis is being performed to maximize therapeutic benefit.

Spurious hyperphosphatemia related to severe hyperbilirubinemia in patients with end-stage liver disease.

AIM: Accurate assessment and management of hyperphosphatemia is a key component of the care of patients with both acute and chronic kidney disease (CKD). In some cases, hyperphosphatemia may be spurious, and failure to recognize this may lead to complications. We report 6 cases of spurious hyperphosphatemia in patients with end-stage liver disease (ESLD) that was associated with severe hyperbilirubinemia. METHODS: Six patients with ESLD and severe hyperbilirubinemia were found to have high serum phosphorus (PO4) using our Beckman Coulter Synchron LX20 or DxC analyzers. Samples were sent to an affiliated hospital that uses the Roche Integra analyzer, for evaluation to rule out spurious elevations of serum phosphorus. We also measured serum levels of parathyroid hormone (PTH), calcium, creatinine, total protein, and total bilirubin. Data were analyzed by t-test. RESULTS: Mean serum PO4 using the Beckman analyzers was 7.5 mg/dL (SD ± 1.98); using the Roche Integra analyzer it was 4.0 mg/dL (SD ± 0.44) (mean difference = 3.5 mg/dL; p = 0.0017). Mean PTH and calcium levels were 43 pg/mL and 9.1 mg/dL, respectively. Mean total bilirubin level was 27.9 mg/dL and mean total protein was 6.0 g/dL. CONCLUSION: The Beckman LX20 and DxC analyzers use time-dependent photometric methods to measure serum PO4 which can be affected by hyperbilirubinemia. In contrast, the Roche Integra analyzer uses an endpoint photometric method with sample blanking, which helps to correct for the effect of hyperbilirubinemia. Clinicians managing patients with marked hyperbilirubinemia should consider spurious laboratory abnormalities.