Early and late assessment of renal allograft dysfunction using intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI): a prospective study.

PURPOSE: To evaluate the ability of the Intravoxel Incoherent Motion (IVIM) and monoexponentially ADC in renal allograft function in the early and late phases of transplantation, and to predict their effectiveness in discrimination of the graft pathology. METHODS: This is a prospective study included participants scanned with quantitative diffusion and perfusion sequences on a 3-T MR scanner (Philips, Ingenia); the ADC and IVIM parameters; were calculated. Correlations and regression analysis with the eGFR, transplantation periods, and pathology were assessed. RESULTS: This study included 105 renal allograft recipients (85 males, and 20 females with mean age = 32.4 ± 11.9 years and age range = 22-61 years). There was a significant positive correlation between the whole parameters of the ADC and IVIM with eGFR however, the cortical parameters showed higher significant correlation coefficients (p < 0.001). Regression analysis revealed the most significant model can predict eGFR groups included cortical pseudo diffusion (D*) and cortical ADC (p < 0.001). In graft dysfunction eGFR was 61.5 ml/min and normal graft was 64 ml/min. This model demonstrates a high performance of an AUC 96% [0.93-0.97]. In the late transplantation, there is a higher correlation with D* compared to ADC, p-values = 0.001. CONCLUSION: IVIM and ADC Values are significant biomarkers for renal allograft function assessment, cortical ADC, and D* had the highest performance even in situations with mild impairment that is not affect the eGFR yet as cases of proteinuria with normal eGFR. Furthermore, D* is superior to ADC in the late assessment of the renal transplant.

Impact of a Clinical Decision Support Alert on Informed Consent Documentation in the Neonatal Intensive Care Unit.

Background: Informed consent is necessary to preserve patient autonomy and shared decision-making, yet compliant consent documentation is suboptimal in the intensive care unit (ICU). We aimed to increase compliance with bundled consent documentation, which provides consent for a predefined set of common procedures in the neonatal ICU from 0% to 50% over 1 year. Methods: We used the Plan-Do-Study-Act model for quality improvement. Interventions included education and performance awareness, delineation of the preferred consenting process, consent form revision, overlay tool creation, and clinical decision support (CDS) alert use within the electronic health record. Monthly audits categorized consent forms as missing, present but noncompliant, or compliant. We analyzed consent compliance on a run chart using standard run chart interpretation rules and obtained feedback on the CDS as a countermeasure. Results: We conducted 564 audits over 37 months. Overall, median consent compliance increased from 0% to 86.6%. Upon initiating the CDS alert, we observed the highest monthly compliance of 93.3%, followed by a decrease to 33.3% with an inadvertent discontinuation of the CDS. Compliance subsequently increased to 73.3% after the restoration of the alert. We created a consultant opt-out selection to address negative feedback associated with CDS. There were no missing consent forms within the last 7 months of monitoring. Conclusions: A multi-faceted approach led to sustained improvement in bundled consent documentation compliance in our neonatal intensive care unit, with the direct contribution of the CDS observed. A CDS intervention directed at the informed consenting process may similarly benefit other ICUs.

Implicit Racial Bias in Evaluation of Neonatal Opioid Withdrawal Syndrome.

OBJECTIVE: To assess implicit bias by administrating the Modified Finnegan Score (MFS) for quantifying neonatal opioid withdrawal and to evaluate risk of decreased opioid treatment of Black versus White infants. STUDY DESIGN: Study participants were nurses recruited from a large tertiary care center who received three clinical vignettes portraying withdrawing infants and were randomized to receive an accompanying photo of either a Black or White infant. MFS results were compared for identical vignettes based on race of infant photo. RESULTS: Out of 275 nurses, 70 completed the survey. In vignette 2, nurses aged ≤35 years scored Black infants lower than White infants (MFS=8.3 ± 2 vs. 9.5 ± 1.2, p=0.012). Nurses with <5 years of experience and ≤10 years of experience also scored Black infants lower for the same vignette (8.2 ± 2.3 vs. 9.6 ± 1.2, p=0.032 and 8.3 ± 2 vs. 9.5 ± 1.2, p=0.0083). CONCLUSION: Implicit bias may contribute to the difference in opioid treatment.

Predicting Heterogeneity in Patient Response to Morphine Treatment for Neonatal Opioid Withdrawal Syndrome.

Infants with neonatal opioid withdrawal syndrome commonly receive morphine treatment to manage their withdrawal signs. However, the effectiveness of this pharmacotherapy in managing the infants' withdrawal signs vary widely. We sought to understand how information available early in infant monitoring can anticipate this treatment response, focusing on early modified Finnegan Neonatal Abstinence Scoring System (FNASS) scores, polygenic risk for opioid dependence (polygenic risk score (PRS)), and drug exposure. Using k-means clustering, we divided the 213 infants in our cohort into 3 groups based on their FNASS scores in the 12 hours before and after the initiation of pharmacotherapy. We found that these groups were pairwise significantly different for risk factors, including methadone exposure, and for in-hospital outcomes, including total morphine received, length of stay, and highest FNASS score. Whereas PRS was not predictive of receipt of treatment, PRS was pairwise significantly different between a subset of the groups. Using tree-based machine learning methods, we then constructed network graphs of the relationships among these groups, FNASS scores, PRS, drug exposures, and in-hospital outcomes. The resulting networks also showed meaningful connection between early FNASS scores and PRS, as well as between both of those and later in-hospital outcomes. These analyses present clinicians with the opportunity to better anticipate infant withdrawal progression and prepare accordingly, whether with expedited morphine treatment or non-pharmacotherapeutic alternative treatments.

Effects of semi-upright swings on vital signs in NICU infants.

BACKGROUND: The aim of this study was to compare the impact of a semi-upright swing with a standard crib on vital signs in infants in the neonatal intensive care unit (NICU). METHODS: We performed a within-subjects' comparison of vital signs of NICU infants corrected to ≥34 weeks of gestation and placed in the supine position versus the semi-upright position in a swing. The primary outcome was the mean oxygen saturation, and the secondary outcomes were the mean heart rate, the proportion of time with oxygen saturation (SpO2) <90%, and respiratory rate. RESULTS: Of the 65 infants, 34 (57%) were male and 32 (50%) were black. The mean ± SD gestational age at birth was 32.4 ± 5.1 weeks. In all, 40% were on noninvasive respiratory support. There were no significant differences in oxygen saturation, heart rate, time with oxygen desaturation defined by SpO2 < 90%, or respiratory rate between the supine and semi-upright positions. A higher risk of desaturations was observed in infants without respiratory support (RR, 1.24, 95% CI, 1.15-1.33) and low-birth-weight infants (RR, 1.55, 95% CI, 1.42-1.69). CONCLUSIONS: The placement of infants in a semi-upright swing resulted in no discernible differences in averaged vital signs compared to the supine position in NICU infants. IMPACT: We identified no significant differences in averaged oxygen saturation, heart rate, or respiratory rate among NICU infants placed in a semi-upright swing compared to the supine position. Desaturation events occurred at a higher frequency in low-birth-weight infants and those on room air when placed in the swing, although none required oxygen supplementation. The results from the current study support that it is probably safe to use semi-upright swings in the NICU environment, although additional studies are necessary for generalization to the unmonitored home environment.

Protective Effect of Litchi chinensis Peel Extract-Prepared Nanoparticles on Rabbits Experimentally Infected with Eimeria stiedae.

The present study used Litchi chinensis peel extract to synthesize silver nanoparticles (AgNPs). This technique is eco-friendly and can be performed in a single step; thus, it has attracted great attention for NPs biosynthesis. Herein, we biosynthesized AgNPs with L. chinensis peel extract and examined their anticoccidial activity in rabbit hepatic coccidiosis induced by E. stiedae infection. Thirty-five rabbits were allocated into seven groups: a healthy group (G1), an infected control group (G2), four groups infected before treatment with 10 mg/kg L. chinensis peel extract-biosynthesized AgNPs (G3, G5) or 50 mg/kg amprolium (G4, G6), and rabbits infected after two weeks of pretreatment with 10 mg/kg L. chinensis eel extract-biosynthesized AgNPs (G7). In this study, both pre-and post-treatment with AgNPs produced a substantial reduction in fecal oocyst output, liver enzyme levels, and histopathological hepatic lesions relative to the infected group. In conclusion, L. chinensis peel extract-prepared AgNPs should be considered harmless and efficient in the cure of hepatic coccidiosis in rabbits.

Effect of maternal adverse childhood experiences (ACE) and cannabis use on pregnancy outcomes.

This study aimed to characterize the relationship between cannabis use, ACE score, and pregnancy outcomes. Pregnant patients in Baltimore, MD, completed the 17-point ACE checklist. Charts of the birth parent and neonate were reviewed for urine toxicology testing at initiation of care and delivery, prenatal care metrics, and birth statistics. Multivariable logistic regression analysis was performed to assess the relationship between ACE score, cannabis use, and pregnancy outcomes. Of 256 birth parents, 87 (34.0%) tested positive for cannabis at initial visit and 39 (15.2%) tested positive for cannabis at delivery. Testing positive for cannabis at initial visit or delivery was associated with higher ACE score (15.1 vs 13.7, p = 0.04; 16.2 vs 13.8, p = 0.01). Of those who tested positive for cannabis at initial visit, 39/87 (45.0%) tested positive at delivery. Continued cannabis use at delivery was associated with lower maternal weight gain (7.9 kg vs 13.3 kg, p = 0.003), fewer prenatal visits (7 vs 8, p = 0.010), and numerically higher mean ACE score. Cannabis use at delivery was associated with 10% lower birthweight (2665 g vs 3014 g p < 0.05) but not with pre-term birth. Total ACE score was not significantly associated with any birth outcome. Worse pregnancy outcomes were associated with cannabis use throughout pregnancy but not with cannabis use at prenatal care initiation. The interplay of ACE and continued cannabis use during pregnancy warrants further research on the physiologic effects of cannabis and interventions to decrease substance use during pregnancy.

Molecular Identification of Newly Recorded Louse Columbicola tschulyschman Eichler (Phthiraptera: Philopteridae) From Saudi Arabia With a Note on Genus Columbicola spp. Phylogeny.

Chewing lice comprise a large group of ectoparasites that colonize and adversely affect several domestic and wild birds including pigeons. In Saudi Arabia, there is a lack of studies describing such ectoparasites and their infestation rates. Through this work, a new record, Columbicola, tschulyschman Eichler (C. tschulyschman Eichler) was collected from domestic pigeons (Columba livia domestica, Linnaeus). The collected C. tschulyschman Eichler was morphologically identified based on specific taxonomic keys. Mitochondrial (COI) and nuclear (EF-1α) gene fragments were used for molecular identification and phylogenetic reconstruction. In this study, the C. tschulyschman Eichler accounted for around 69.40%. To our knowledge, this is the first report of C. tschulyschman Eichler in Riyadh, Saudi Arabia. To improve the tree topology and differentiate between genera, further studies should utilize the 16s rRNA.

Microbiological investigation study for Apis mellifera yemenitica and Apis mellifera carnica bee venoms on selected bacterial strains.

Bees are one of the ancient and the most social insects worldwide. They are of great economic and medical importance. Bee venom (BV) has many therapeutic effects and has been used since ancient times for the treatment of many diseases. The present study aimed to evaluate and compare the antibacterial effect of BV from two different bee subspecies Apis mellifera yemenitica (A. m. yemenitica) (indigenous strain) and Apis mellifera carnica (A. m. carnica) (carniolan strain) against selected Gram-positive and Gram-negative bacteria. Experimentally, venoms were extracted using an electrical venom collector from honey bee colonies of the subspecies, A. m. yemenitica and A. m. carnica, in Hail, Saudi Arabia. Each venom was tested against selected medically important Gram-negative strains, Salmonella Typhimurium, Pseudomonas aeruginosa, and Escherichia coli, while Staphylococcus aureus was selected as Gram-positive test organism. The minimum inhibitory concentration (MIC) method was used to compare the effect of BV from the two subspecies on the growth of the selected bacterial strains. Results showed that BV from both subspecies could equally inhibit the growth of Salmonella Typhimurium, Pseudomonas aeruginosa, and Escherichia coli at an MIC of 10 mg/ml. However, S. aureus was inhibited by an MIC of 5 and 10 mg/ml of BV from A. m. carnica and A. m. yemenitica, respectively. This suggested that the BV of the carnica subspecie was more inhibitory to this Gram-positive pathogen than its counterpart produced by the yemenitica subspecies. The present study shows that bee venom has a promising antibacterial effect.

Alterations in motor functional connectivity in Neonatal Hypoxic Ischemic Encephalopathy.

BACKGROUND: Neonatal hypoxic-ischemic encephalopathy (HIE) is the result of global hypoxic-ischemic brain injury in neonates due to asphyxia during birth and is one of the most common causes of severe, long-term neurologic deficits in children. Methods: Resting state fMRI (rs-fMRI) was used to assess potential functional disruptions in the primary and association motor areas in HIE neonates (n = 16) compared to healthy controls (n = 11). RESULTS: Results demonstrate reduced intra-hemispheric resting state functional connectivity (rs-FC) between primary motor regions (upper extremity and facial motor regions) as well as reduced inter-hemispheric rs-FC in the HIE group. In addition, HIE neonates demonstrated increased rs-FC between motor regions and frontal, temporal and parietal cortices but decreased rs-FC with the cerebellum. DISCUSSION: These preliminary results provide initial evidence for the disruption of functional communication with the motor network in neonates with HIE. Further studies are necessary to both validate these findings in a larger dataset as well as to determine if rs-fMRI measurements collected at birth may have the potential to serve as a prognostic marker in addition to the traditional combination of clinical measurements and conventional MRI.

Molecular Detection of Tick-Borne Rickettsial Pathogens Associated with the Arabian Camel (Camelus dromedarius) in Riyadh and the Eastern Region, Saudi Arabia.

BACKGROUND: In Saudi Arabia, records on molecular identification of tick-borne infections in camels are relatively scarce; few molecular epidemiological studies have been conducted. OBJECTIVE: This study aimed to find Anaplasma species and Piroplasma spp. in camels from Riyadh and the Eastern Region, Saudi Arabia. ANIMALS: A total of 1369 blood samples were collected from camels from Riyadh and the Eastern Region and analyzed for the DNA of Anaplasma and Piroplasma species by polymerase chain reaction (PCR). RESULTS: Piroplasma spp. infection was not observed in any of the blood samples. 616 camels (44.99%) were found to be positive for Anaplasma infection by PCR targeting the 16S rRNA and COX1 genes. Six Anaplasma sequences for the 16S rRNA gene (OK481101-OK481106) were deposited in GenBank and six for the COX1 gene (OK490994-OK490999). They showed 98.3% and 62.7% similarities with Anaplasma marginale (A. marginale) detected in Kenya and Brazil, respectively. Phylogenetic studies revealed that the 12 sequences reported in this study were closely related; they were found in the same cluster as A. marginale isolates previously recorded in South Africa, Brazil, USA, China, and Israel. CONCLUSION: Finally, 12 Anaplasma sequences closely related to A. marginale were detected in camels in Riyadh and the Eastern Region, Saudi Arabia. Camels in these areas were confirmed to be free of Piroplasma.

Comparative study for treatment of alopecia areata using carboxy therapy, intralesional corticosteroids, and a combination of both.

Alopecia Areata (AA) is a common autoimmune disease, with an unpredictable course and no standard treatment with guaranteed outcome. Intralesional corticosteroids is the most commonly used treatment for patchy AA, but with a common side effect of localized atrophy. Thirty patients with localized AA, with three patches were included in this study. Each alopecic patch in each patient was subjected to treatment by intralesional carbon dioxide injection (carboxy therapy), intralesional corticosteroids (ILC) and a combination of both. Sessions were done every 2 weeks for a total of 12 weeks, followed by a 2-month follow-up period. Evaluation was done at baseline, after treatment and after follow-up, clinically by modified SALT score (a novel modification of the SALT score), dermoscopically (yellow dots, black dots, tapered hair, regrowing hair) and by photography. All treatment regimens resulted in significant improvement of mSALT score and dermoscopic parameters. Comparison of the three treatment modalities revealed a 79.2% hair regrowth following the combined regimen, 69.5% improvement after ILC, and 50% improvement after carboxy therapy, with a statistical difference. The combined regimen also produced the largest significant increase in regrowing hair after treatment. Side effects included temporary pain during injection and relapse in the alopecic patch treated by ILC in one patient. All treatment regimens proved effective for treatment of patchy alopecia areata, with highest efficacy encountered following the combined modality as it caused the greatest and earliest hair regrowth.Study registered in Protocol Registration and Results System (clincaltrials.gov). Registration number: NCT04228029.

Identification of Theileria spp. in sheep and goats from Jeddah, Saudi Arabia, using molecular techniques.

BACKGROUND: Thileriosis is a tick -born disease caused by hemoprotozoan parasites which has global veterinary and economic implications. METHODS: Blood samples were collected from 216 sheep and 83 goats from Jeddah, Saudi Arabia, were analyzed to determine whether the animals were infected with Theileria spp. parasites. The parasites were detected using a polymerase chain reaction (PCR) targeting the gene of 18S rRNA followed by sequencing. RESULTS: According to obtained findings, Theileria spp. were detected in sheep (57.8%, 48/83) and goats (51.9%, 112/216). Phylogenetic analysis to sequence data showed that T. ovis identified in this study were found to be closely connected to an isolate from Turkey, with 84.4-99.8% pairwise identity and 52.35-99.79% coverage.

Prevalence of head lice (Pediculus humanus capitis) infestation among schools workers in the Eastern Region, Saudi Arabia.

In a cross-sectional survey in February-May 2019, the prevalence of Pediculosis capitis with demographic data and the behavioral practices were investigated among 750 participants in the Eastern region of Saudi Arabia. Female participation was highly remarked with a percentage of 94.08% compared to that of male one about 5.91%. A deficiency of knowledge about lice infestation was noted especially among illiterate participants raised from their socio-economic levels (p-value = 0.001). Lice infestation reached higher rates in children aged less than 20 years with itching of the hair scalp. The obtained results revealed that 59.33% of the respondents believed that frequency of personal hygiene and washing of hair were the best methods for preventing the lice infestation. However, the treatment of lice infestation using anti-lice agents (p-value = 0.020) was preferred by 14.26% of participants. Although knowledge about the preventive tools for lice infestation (p-value 0.089) was not significantly associated with the experience of infestation but knowledge about the appropriate treatment to kill lice (p-value 0.020) and the wrong practices in the treatment of a head lice infestation were (p-value 0.005) significantly associated with the experience of infestation. Health programs and campaigns preventions are highly advised to increase the awareness of Pediculosis capitis with an effective strategic plan to control, manage, and prevent this disease.

Farmers' knowledge, perception and management of mango mealy bug, Drosicha mangiferae Green (Hemiptera: Monophlebidae), on Mangifera indica in Punjab, Pakistan.

In 2004-05, during the December to February about 141 mango farmers were interviewed during peak activity of mango mealy bug in southern Punjab, Pakistan. The objective was to know the farmers' knowledge, perceptions and practices in the management of mango mealy bug. Most of the farmers (94.33%) reported that Chaunsa variety (king of all mango varieties) was susceptible to mango and irrigation water was the major source of flare up of this pest. Basudin and Supracide were the most commonly used insecticides as 72.92 and 51.77 percent farmers gave positive response and grease bands were applied for the control of mango mealy bug by the majority of the respondents. Hundred percent yield losses was told by 22.7 percent respondents whereas 75 percent, 50 percent and 25 percent losses were reported by 39.7, 31.9 and 14.2 insecticidal spray did not show satisfaction to the respondents for the control of fertilized females of mango mealy bug coming down from the trees. Lack of knowledge about the pest, lack of money, adulterated and shortage of pesticides, lack of unity amongst farmers Further the growers' views were tested in the field for confirmation and small land holdings were the main constraints for the control of mango mealy bug.

Effectiveness of naturally occurring Aphis gossypii on tomato plants as a bio-indicator for heavy metals in Riyadh and Hafar Al-Batin, Saudi Arabia.

Although certain pollutants can be biologically degraded by microorganisms, rendering their impact short-term, others can not be impaired, such that their effect persists. The present study evaluates the effectiveness of using a field-collected aphid, Aphis gossypii, as a bio-indicator for heavy metals in tomato farms in Riyadh and Hafar Al-Batin, Saudi Arabia. Heavy metals were selected (Cd, Cu, Zn, and Pb) and measured for comparative screening in field-collected plants, soil, and aphids using inductively coupled plasma-mass spectrometry (ICP-MS). Field-collected aphids from both studied regions were identified as Aphis gossypii. In Riyadh, there was no significant difference observed for Cd, Cu, and Zn for all experimental samples, while, Pb was showed differences among samples especially tomato leaves None of the studied samples in Hafar Al-Batin were showed statistically significant differences in Cd, in reverse to significant differences in the other heavy metals. Comparing concentrations of selected heavy metals between the two studied regions was showed that neither region showed a significant difference in heavy metals except for Cu. This study demonstrates that tomato leaf samples showed the highest concentrations of most studied heavy metals, followed by soil, then aphids. Aphids were utilized as a bio-indicator of heavy metals in the studied regions.