Roles and challenges of primary healthcare workers: lessons learned from COVID-19 pandemic.

Context: The COVID-19 pandemic has changed the structure of the healthcare system. As a response to the pandemic, the ministry of health applied many changes to the primary healthcare system. These changes created new challenges for healthcare workers (HCWs). Aims: To identify the roles and challenges of practitioners in primary healthcare (PHC) centers during COVID-19 in Al-Baha city, Saudi Arabia, in 2022. Methods and Materials: An analytical cross-sectional study was carried out in 2022 in Al-Baha city, Saudi Arabia. An electronic online questionnaire was distributed formally to HCWs in PHC centers. All primary HCWs during the COVID-19 pandemic in Al-Baha city, Saudi Arabia, were included. Results: A total of 424 responses were analyzed. Half (50.7%) of the participants had fieldwork roles during the pandemic. The two most commonly agreed-upon challenges were stress (78.7%) and worry about getting infected (79.8%). The majority (74.4%) of the participants' roles involved direct contact with suspected COVID-19 cases, whereas 50.9% involved direct contact with confirmed COVID-19 cases. Direct contact with confirmed cases showed a significant association with worrying about getting infected (P = 0.019). Conclusions: Workload, overtime, conflict ambiguity, fear of getting and transmitting the infection, stress, and lack of personal protective equipment were challenges faced by the primary HCWs, which negatively impacted the quality of delivered services and mental health. We recommend facilitating access of primary HCWs to psychiatric clinics to improve stress and help cope with new roles during the pandemics and changes in the healthcare system.

A modified trans-anconeus approach to facilitate fixation of a posterior radial head fracture: a cadaveric feasibility study.

Fixation of radial head fracture with minimally invasive posterior approach remains a significant challenge. The aim of this study was to determine the feasibility of trans-anconeus posterior elbow approach and to observe lateral ulnar collateral ligament (LUCL) in extended elbows. This cadaveric study was performed in twenty upper limbs of fresh fixed adult male cadavers. An oblique incision was made in the middle segment of anconeus until the lateral ligament complex and the joint capsule had been revealed. A deep dissection was explored to observe the anatomical relationship of the LUCL to the anconeus. Measurements of the LUCL were recorded while the elbow was fully extended. The mean distance between the edge of the radial head and the proximal insertion of the LUCL was 13.3 mm (11.5-16.2 mm); the mean distance between the edge of the radial head and the distal insertion of the LUCL was 20.9 mm (19.2-23.4 mm); the distance between the edge of the radial head and the distal edge of the annular ligament was 11.2 mm (8.22-11.7 mm). By estimate correlation of the previous measurements, the direct and accessible way to expose the posterolateral articular capsule of the elbow joint was through a window in medial 2/3 of the middle segment of anconeus muscle. These trans-anconeus approach is useful. It provides good visualization, facilitates applying the implants, and lessens the risk of radial nerve injury. Awareness of the anatomy is mandatory to avoid injury of LUCL.

Imaging Transcriptomics in Neurodegenerative Diseases.

Imaging transcriptomics investigates the relationship between neuroanatomical/neuroimaging features and gene expression. The spatial and temporal distribution of the expressed genes and their pattern of spreading over time can contribute to elucidating cellular and molecular processes involved in neurodegeneration. In this study, we review recent findings regarding the correlation between neuroimaging and expression data in neurodegenerative diseases with a focus on Alzheimer's disease and Parkinson's disease. An association between gene expression data and different neuroimaging neurodegeneration features, such as R2 relaxation time and volumetric cortical atrophy, was established. Several positive and negative expression correlations were identified, and they confirmed the focal nature of neurodegeneration. Positively correlated genes were associated with cell motility, immune system activity, neuroinflammation, and microglia. Data from connectome studies support the hypothesis of selective network vulnerability and a temporal spreading pattern in neurodegenerative pathologies. Genes related to cellular mobility and transport are overexpressed in the neuroimaging-defined delineated areas of degeneration. In addition, expression enrichment of genes involved in immunological processes in vulnerable regions-such as the Toll-like receptor, a receptor involved in innate immunity-plays a major role in neuroinflammation in neurodegenerative diseases. However, substantial limitations must be overcome in future studies: the lack of high-quality resolution expression data, the lack of standardized study protocols, and insufficient sensitive early stage neuroimaging markers of degeneration. Identifying neuroimaging and expression prodromal biomarkers and investigating their causal relation in the preclinical disease stage may enable early targeted therapy before the onset of irreversible brain changes.

Morphometric analysis of vastus medialis oblique muscle and its influence on anterior knee pain.

Healthy knees require full range squatting movements. Vastus medialis (VM) muscle regulates and adjusts the extensor apparatus that influences the patellofemoral function. This work was designed to investigate the anatomy and morphometry of vastus medialis oblique (VMO) muscle by widely used imaging techniques and investigate how VMO muscle participates in anterior knee pain. Ten dissected cadaveric specimens were examined, focusing on fiber orientations, origin, insertions and nerve supply of VMO muscle. Magnetic resonance imaging and ultrasound of VMO muscle were recorded. Anatomical cross-sectional areas of VMO muscle were determined in painless and painful knees and statistically analyzed. In cadaveric specimens, there was distinct separation between VM longus and VMO (change in fiber angle or fibro-fascial plane). VMO inserted directly into the medial proximal margin of the patella, capsule of the knee joint and continuous with the patellar tendon. Separate branch of femoral nerve run along the anteromedial border of the muscle. Anatomical cross-sectional area was significantly decreased in painful knee by -17.2%±11.0% at lower end of shaft of femur, -21.1%±6.0% at upper border of patella, -36.7%±11.0% at mid-patellar level. VMO is distinct muscle within quadriceps femoris group. VMO muscle would track the patella medially and participate in last phase of knee extension. Assessment of the VMO muscle anatomical cross-sectional area by ultrasonography may constitute promising and reliable tool to evaluate patellofemoral pain syndrome staging.

Workplace lighting for improving alertness and mood in daytime workers.

BACKGROUND: Exposure to light plays a crucial role in biological processes, influencing mood and alertness. Daytime workers may be exposed to insufficient or inappropriate light during daytime, leading to mood disturbances and decreases in levels of alertness. OBJECTIVES: To assess the effectiveness and safety of lighting interventions to improve alertness and mood in daytime workers. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, seven other databases; ClinicalTrials.gov and the World Health Organization trials portal up to January 2018. SELECTION CRITERIA: We included randomised controlled trials (RCTs), and non-randomised controlled before-after trials (CBAs) that employed a cross-over or parallel-group design, focusing on any type of lighting interventions applied for daytime workers. DATA COLLECTION AND ANALYSIS: Two review authors independently screened references in two stages, extracted outcome data and assessed risk of bias. We used standardised mean differences (SMDs) and 95% confidence intervals (CI) to pool data from different questionnaires and scales assessing the same outcome across different studies. We combined clinically homogeneous studies in a meta-analysis. We used the GRADE system to rate quality of evidence. MAIN RESULTS: The search yielded 2844 references. After screening titles and abstracts, we considered 34 full text articles for inclusion. We scrutinised reports against the eligibility criteria, resulting in the inclusion of five studies (three RCTs and two CBAs) with 282 participants altogether. These studies evaluated four types of comparisons: cool-white light, technically known as high correlated colour temperature (CCT) light versus standard illumination; different proportions of indirect and direct light; individually applied blue-enriched light versus no treatment; and individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder.We found no studies comparing one level of illuminance versus another.We found two CBA studies (163 participants) comparing high CCT light with standard illumination. By pooling their results via meta-analysis we found that high CCT light may improve alertness (SMD -0.69, 95% CI -1.28 to -0.10; Columbia Jet Lag Scale and the Karolinska Sleepiness Scale) when compared to standard illumination. In one of the two CBA studies with 94 participants there was no difference in positive mood (mean difference (MD) 2.08, 95% CI -0.1 to 4.26) or negative mood (MD -0.45, 95% CI -1.84 to 0.94) assessed using the Positive and Negative Affect Schedule (PANAS) scale. High CCT light may have fewer adverse events than standard lighting (one CBA; 94 participants). Both studies were sponsored by the industry. We graded the quality of evidence as very low.We found no studies comparing light of a particular illuminance and light spectrum or CCT versus another combination of illuminance and light spectrum or CCT.We found no studies comparing daylight versus artificial light.We found one RCT (64 participants) comparing the effects of different proportions of direct and indirect light: 100% direct lighting, 70% direct lighting plus 30% indirect lighting, 30% direct lighting plus 70% indirect lighting and 100% indirect lighting. There was no substantial difference in mood, as assessed by the Beck Depression Inventory, or in adverse events, such as ocular, reading or concentration problems, in the short or medium term. We graded the quality of evidence as low.We found two RCTs comparing individually administered light versus no treatment. According to one RCT with 25 participants, blue-enriched light individually applied for 30 minutes a day may enhance alertness (MD -3.30, 95% CI -6.28 to -0.32; Epworth Sleepiness Scale) and may improve mood (MD -4.8, 95% CI -9.46 to -0.14; Beck Depression Inventory). We graded the quality of evidence as very low. One RCT with 30 participants compared individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder. There was no substantial difference in alertness levels (MD 7.00, 95% CI -10.18 to 24.18), seasonal affective disorder symptoms (RR 1.60, 95% CI 0.81, 3.20; number of participants presenting with a decrease of at least 50% in SIGH-SAD scores) or frequency of adverse events (RR 0.53, 95% CI 0.26 to 1.07). Among all participants, 57% had a reduction of at least 50% in their SIGH-SAD score. We graded the quality of evidence as low.Publication bias could not be assessed for any of these comparisons. AUTHORS' CONCLUSIONS: There is very low-quality evidence based on two CBA studies that high CCT light may improve alertness, but not mood, in daytime workers. There is very low-quality evidence based on one CBA study that high CCT light may also cause less irritability, eye discomfort and headache than standard illumination. There is low-quality evidence based on one RCT that different proportions of direct and indirect light in the workplace do not affect alertness or mood. There is very low-quality evidence based on one RCT that individually applied blue-enriched light improves both alertness and mood. There is low-quality evidence based on one RCT that individually administered bright light during the afternoon is as effective as morning exposure for improving alertness and mood in subsyndromal seasonal affective disorder.

Anatomical bases of endoscopic tarsal tunnel release: anatomical and ultra-sonographic study with a preliminary clinical report.

PURPOSE: The purpose of our study is to present the anatomical bases of a new technique for endoscopic tarsal release and to report the preliminary clinical outcome for this technique. METHOD: Anatomical study The technique was performed on 12 intact adult lower limb specimens. The location of portals was evaluated as well as the integrity of the neurovascular bundle. Ultra-sonographic study A prospective case control study was done on 10 patients (11 feet) and 14 normal volunteers (28 feet). Three parameters were measured; the thickness of flexor retinaculum, the nerve cross-section area and the depth of tarsal tunnel. Clinical study Seven patients with idiopathic proximal Tarsal Tunnel Syndrome (TTS) were treated by endoscopic TTR using a modified trocar cannula and dilator system. Preoperative and postoperative evaluation was done by electrophysiological studies and ultra-sonography. Evaluation was done using Takakura's rating scale. RESULTS: Anatomical study The proximal and distal portals were located at 13 mm (±1.59 STD) and 17.91 mm (±1.44 STD) from the proximal and distal borders of FR, respectively. There was intact neurovascular bundle in all specimens. Ultra-sonographic study There was statistically significant difference in the mean nerve cross-sectional area and the thickness of the FR between the control group and the patients group (P < 0.05). Clinical study The mean TRS improved from 2.28 ± 1.11 STD preoperatively to 8.43 ± 0.97 at 2 years follow-up. The overall good to excellent results was 85.7%. CONCLUSION: Based on this preliminary clinical study, endoscopic tarsal tunnel release by the technique described could obtain excellent to good results in 85.7% of patients with idiopathic proximal tarsal tunnel. The anatomical study proved the safety of the technique on the neurovascular structures. Ultra-sonography was an effective tool for preoperative diagnosis and postoperative follow-up. LEVEL OF EVIDENCE: Case series study, Level IV.

Endosopic achilles tendon augmentation with a graft loop anatomic and radiologic study.

BACKGROUND: Mini-invasive techniques are commonly used for repair of tendon Achilles (TA) rupture. However, the use of these techniques is limited when graft augmentation is needed. METHOD: A radiological study was conducted on 18 normal ankles using multi-slice CT scan with soft tissue reconstruction to determine the endoscopic landmarks for Achilles tendon insertion. The surgical procedure was performed on six whole lower limb formaldehyde preserved specimens. Endoscopic-assisted TA augmentation with a graft loop was done for all specimens. Postoperative assessment of the tunnel was done using multi-slice CT scan. RESULTS: Anatomic dissection showed that the sural nerve and neurovascular bundle were intact in all specimens. CONCLUSION: With the technique described a graft loop can be delivered endoscopically for Achilles tendon augmentation. The technique was found to be safe for the sural nerve and medial neurovascular structures.

The antifungal protein AFP from Aspergillus giganteus prevents secondary growth of different Fusarium species on barley.

Secondary growth is a common post-harvest problem when pre-infected crops are attacked by filamentous fungi during storage or processing. Several antifungal approaches are thus pursued based on chemical, physical, or bio-control treatments; however, many of these methods are inefficient, affect product quality, or cause severe side effects on the environment. A protein that can potentially overcome these limitations is the antifungal protein AFP, an abundantly secreted peptide of the filamentous fungus Aspergillus giganteus. This protein specifically and at low concentrations disturbs the integrity of fungal cell walls and plasma membranes but does not interfere with the viability of other pro- and eukaryotic systems. We thus studied in this work the applicability of AFP to efficiently prevent secondary growth of filamentous fungi on food stuff and chose, as a case study, the malting process where naturally infested raw barley is often to be used as starting material. Malting was performed under lab scale conditions as well as in a pilot plant, and AFP was applied at different steps during the process. AFP appeared to be very efficient against the main fungal contaminants, mainly belonging to the genus Fusarium. Fungal growth was completely blocked after the addition of AFP, a result that was not observed for traditional disinfectants such as ozone, hydrogen peroxide, and chlorine dioxide. We furthermore detected reduced levels of the mycotoxin deoxynivalenol after AFP treatment, further supporting the fungicidal activity of the protein. As AFP treatments did not compromise any properties and qualities of the final products malt and wort, we consider the protein as an excellent biological alternative to combat secondary growth of filamentous fungi on food stuff.