Accuracy and perceptions of teledentistry in KSA during the COVID-19 pandemic: A single-centre randomised controlled trial.

Objective: Teledentistry conveniently delivers dental care when in-person visits are restricted, such as during the COVID-19 pandemic. This study aimed to assess Saudi Arabian patients' accuracy, perceptions, knowledge, attitudes, and challenges regarding teledentistry used for diagnosis during the COVID-19 pandemic, as well as its accuracy, versus traditional dental visits. Methods: A single-blind, parallel-group randomised controlled trial design was used. The 70 participants were randomised equally into study and control groups. While the control group waited, the study group received teledentistry diagnoses which were compared with baseline clinical examinations retrieved from the UQU dental hospital, Makkah, KSA. After the intervention was completed, all participants answered a questionnaire. Results: There were no significant differences between the groups in knowledge or attitudes regarding teledentistry. However, study group participants had more favourable experiences with teledentistry. They reported good accuracy with diagnosis and recording of their chief complaints (74.3%), number of missing teeth (74.3%), number of filled teeth (71.4%), and oral hygiene status (65.7%). Additionally, moderate accuracy was reported on recording of health complaints (51.4%) and number of decayed teeth (40.?%). The number of decayed teeth and the decayed, missing, and filled teeth (DMF) index scores reported using teledentistry were significantly (p < 0.05) higher than reported in the baseline examinations. Conclusion: Teledentistry is widely accepted by patients and can be efficient for preliminary examinations, particularly during pandemic lockdowns or in more frequently occurring situations such as severe weather conditions, but subsequent clinical examination is necessary for maximally accurate diagnoses.

Dengue meningoencephalitis in a child presenting with focal seizures.

We report a 9-year-old female child who presented with fever and focal seizures. The Cerebrospinal Fluid (CSF) analysis was compatible with viral meningoencephalitis and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) on same sample was positive for dengue virus RNA, serotype 2. The dengue IgM in blood sample was positive on the 8th day of the illness. This case demonstrates the emerging neurological manifestations of dengue infection and the first confirmed pediatric meningoencephalitis reported from Saudi Arabia. In areas where it does exist, dengue should be included in the differential diagnosis of cases of viral meningitis or meningoencephalitis.

Sputum proteomic signature of gastro-oesophageal reflux in patients with severe asthma.

Gastro-oesophageal reflux disease (GORD) has long been associated with poor asthma control without an established cause-effect relationship. 610 asthmatics (421 severe/88 mild-moderate) and 101 healthy controls were assessed clinically and a subset of 154 severe asthmatics underwent proteomic analysis of induced sputum using untargeted mass spectrometry, LC-IMS-MSE. Univariate and multiple logistic regression analyses (MLR) were conducted to identify proteins associated with GORD in this cohort. When compared to mild/moderate asthmatics and healthy individuals, respectively, GORD was three- and ten-fold more prevalent in severe asthmatics and was associated with increased asthma symptoms and oral corticosteroid use, poorer quality of life, depression/anxiety, obesity and symptoms of sino-nasal disease. Comparison of sputum proteomes in severe asthmatics with and without active GORD showed five differentially abundant proteins with described roles in anti-microbial defences, systemic inflammation and epithelial integrity. Three of these were associated with active GORD by multiple linear regression analysis: Ig lambda variable 1-47 (p = 0·017) and plasma protease C1 inhibitor (p = 0·043), both in lower concentrations, and lipocalin-1 (p = 0·034) in higher concentrations in active GORD. This study provides evidence which suggests that reflux can cause subtle perturbation of proteins detectable in the airways lining fluid and that severe asthmatics with GORD may represent a distinct phenotype of asthma.

Medial elbow stability assessment after ultrasound-guided ulnar collateral ligament transection in a cadaveric model: ultrasound versus stress radiography.

BACKGROUND: The ulnar collateral ligament (UCL), consisting of 3 bundles, is the primary medial restraint in the elbow. Recent research has demonstrated that ultrasound is an effective modality to evaluate the medial elbow, whereas stress radiography is standard practice in the measurement of medial elbow laxity. This study (1) compared dynamic ultrasound (USD) with stress radiography in the evaluation of UCL insufficiency and (2) further evaluated the contribution of the anterior bundle of the UCL to medial elbow stability. METHODS: Stress radiographs and USD were used to obtain coronal plane measurements of the medial joint space of 16 cadaveric elbows before and after USD-guided isolated transection of the anterior bundle of the UCL. Measurements were performed with and without a valgus stress applied to the elbows, and gapping of the ulnohumeral joint space was documented. RESULTS: Transection of the anterior bundle of the UCL resulted in 1.5 mm and 1.7 mm of additional gapping in the ulnohumeral joint as measured with stress radiographs and USD, respectively. No differences were recorded in the ulnohumeral gapping measurements between stress radiography and USD. CONCLUSIONS: The lack of difference between measurements reveals USD is as reliable as stress radiography in evaluating the medial ulnohumeral joint space and continuity of the UCL while eliminating radiation exposure and minimizing cost of the diagnostic examination. The increase in ulnohumeral gapping with isolated transection of the anterior bundle of the UCL demonstrates its significant contribution to medial elbow stability.

Association of Helicobacter pylori and protozoal parasites in patients with chronic diarrhoea.

Introduction An association of Helicobacter pylori and common protozoal parasites in patients with abdominal discomfort and chronic diarrhoea is unclear and may be pathological. Materials and methods One hundred and sixty-one patients with diarrhoea were compared to 114 age and sex matched controls. Stool samples were examined by microscopy and DNA extracted for PCR with specific primers for H. pylori and protozoal parasites Blastocystis sp., Entamoeba sp. (Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii) and Giardia duodenalis (G. duodenalis). Results There was a marked difference in the presence of parasites between patients and controls: no parasite 42/75%, one parasite 42/15%, two or more parasites 16/10%, respectively (p < 0.001). Patients with diarrhoea were more likely to be infected with Blastocystis sp (p < 0.001), E. histolytica (p = 0.027) and E moshkovskii (p = 0.003). There was no difference in the frequency of H. pylori (p = 0.528), G duodenalis (p = 0.697) or E dispar (p = 0.425). Thirty-three patients and 27 controls had H. pylori infection. Of these, 22 patients and 6 controls were infected with Blastocystis sp (p = 0.001), 6 patients and no controls were infected with E. histolytica (p = 0.02), whilst 7 patents and 9 controls were infected with E dispar (p = 0.292). Conclusion In this population, diarrhoea is linked to infection with Blastocystis sp, E. histolytica and E moshkoviskii. In H. pylori infection, diarrhoea is linked to Blastocystis sp and E. histolytica infection. These associations may be linked pathogenically.

Allergenic proteases cleave the chemokine CX3CL1 directly from the surface of airway epithelium and augment the effect of rhinovirus.

CX3CL1 has been implicated in allergen-induced airway CD4+ T-lymphocyte recruitment in asthma. As epidemiological evidence supports a viral infection-allergen synergy in asthma exacerbations, we postulated that rhinovirus (RV) infection in the presence of allergen augments epithelial CX3CL1 release. Fully differentiated primary bronchial epithelial cultures were pretreated apically with house dust mite (HDM) extract and infected with rhinovirus-16 (RV16). CX3CL1 was measured by enzyme-linked immunosorbent assay and western blotting, and shedding mechanisms assessed using inhibitors, protease-activated receptor-2 (PAR-2) agonist, and recombinant CX3CL1-expressing HEK293T cells. Basolateral CX3CL1 release was unaffected by HDM but stimulated by RV16; inhibition by fluticasone or GM6001 implicated nuclear factor-κB and ADAM (A Disintegrin and Metalloproteinase) sheddases. Conversely, apical CX3CL1 shedding was stimulated by HDM and augmented by RV16. Although fluticasone or GM6001 reduced RV16+HDM-induced apical CX3CL1 release, heat inactivation or cysteine protease inhibition completely blocked CX3CL1 shedding. The HDM effect was via enzymatic cleavage of CX3CL1, not PAR-2 activation, yielding a product mitogenic for smooth muscle cells. Extracts of Alternaria fungus caused similar CX3CL1 shedding. We have identified a novel mechanism whereby allergenic proteases cleave CX3CL1 from the apical epithelial surface to yield a biologically active product. RV16 infection augmented HDM-induced CX3CL1 shedding-this may contribute to synergy between allergen exposure and RV infection in triggering asthma exacerbations and airway remodeling.

Gastric lymphoma: association with Helicobacter pylori outer membrane protein Q (HopQ) and cytotoxic-pathogenicity activity island (CPAI) genes.

B-cell non-Hodgkin lymphoma (B-cell NHL) is the second commonest malignancy in the stomach. We determined the distribution of Helicobacter pylori outer membrane protein Q (HopQ) allelic type, cytotoxin-associated gene (cag)-pathogenicity activity island (cag-PAI) and vacuolation activating cytotoxin A (vacA) genes, respectively, in patients with B-cell NHL. We also compared them with their distribution in non-ulcer dyspepsia (NUD). H. pylori was cultured from gastric biopsy tissue obtained at endoscopy. Polymerase chain reaction was performed. Of 170 patients enrolled, 114 (63%) had NUD and 56 (37%) had B-cell NHL. HopQ type 1 was positive in 66 (58%) in NUD compared with 46 (82%) (P = 0·002) in B-cell NHL; HopQ type 2 was positive in 93 (82%) with NUD compared with 56 (100%) (P < 0·001) in B-cell NHL. Multiple HopQ types were present in 46 (40%) in NUD compared with 46 (82%) (P < 0·001) in B-cell NHL. CagA was positive in 48 (42%) in NUD vs. 50 (89%) (P < 0·001) in B-cell NHL; cagT was positive in 35 (31%) in NUD vs. 45 (80%) (P < 0·001) in B-cell NHL; left end of the cagA gene (LEC)1 was positive in 23 (20%) in NUD vs. 43 (77%) (P < 0·001) in B-cell NHL. VacAs1am1 positive in B-cell NHL in 48 (86%) (P < 0·001) vs. 50 (44%) in NUD, while s1am2 was positive in 20 (17%) in NUD vs. 46 (82%) (P < 0·001) in B-cell NHL. H. pylori strains with multiple HopQ allelic types, truncated cag-PAI evidenced by expression of cagA, cagT and cag LEC with virulent vacAs1 alleles are associated with B-cell NHL development.

Assessment of the Interrater Reliability of the Congress of Neurological Surgeons Microanastomosis Assessment Scale.

BACKGROUND: The potential for simulation-based learning in neurosurgical training has led the Congress of Neurosurgical Surgeons to develop a series of simulation modules. The Northwestern Objective Microanastomosis Assessment Tool (NOMAT) was created as the corresponding assessment tool for the Congress of Neurosurgical Surgeons Microanastomosis Module. The face and construct validity of the NOMAT have been previously established. OBJECTIVE: To further validate the NOMAT by determining its interrater reliability (IRR) between raters of varying levels of microsurgical expertise. METHODS: The NOMAT was used to assess residents' performance in a microanastomosis simulation module in 2 settings: Northwestern University and the Society of Neurological Surgeons 2014 Boot Camp at the University of Indiana. At Northwestern University, participants were scored by 2 experienced microsurgeons. At the University of Indiana, participants were scored by 2 postdoctoral fellows and an experienced microsurgeon. The IRR of NOMAT was estimated by computing the intraclass correlation coefficient using SPSS v22.0 (IBM, Armonk, New York). RESULTS: A total of 75 residents were assessed. At Northwestern University, 21 residents each performed microanastomosis on 2 model vessels of different sizes, one 3 mm and one 1 mm. At the University of Indiana, 54 residents performed a single microanastomosis procedure on 3-mm vessels. The intraclass correlation coefficient of the total NOMAT scores was 0.88 at Northwestern University and 0.78 at the University of Indiana. CONCLUSION: This study indicates high IRR for the NOMAT. These results suggest that the use of raters with varying levels of expertise does not compromise the precision or validity of the scale. This allows for a wider adoption of the scale and, hence, a greater potential educational impact.

Blue light-induced immunosuppression in Bactrocera dorsalis adults, as a carryover effect of larval exposure.

Detrimental effects of ultraviolet (UV) light on living organisms are well understood, little is known about the effects of blue light irradiation. Although a recent study revealed that blue light caused more harmful effects on insects than UV light and blue light irradiation killed insect pests of various orders including Diptera, the effects of blue light on physiology of insects are still largely unknown. Here we studied the effects of blue light irradiation on cuticular melanin in larval and the immune response in adult stage of Bactrocera dorsalis. We also evaluated the effects of blue light exposure in larval stage on various age and mass at metamorphosis and the mediatory role of cuticular melanin in carryover effects of larval stressors across metamorphosis. We found that larvae exposed to blue light decreased melanin contents in their exoskeleton with smaller mass and delayed metamorphosis than insects reared without blue light exposure. Across metamorphosis, lower melanotic encapsulation response and higher susceptibility to Beauveria bassiana was detected in adults that had been exposed to blue light at their larval stage, thereby constituting the first evidence that blue light impaired adult immune function in B. dorsalis as a carryover effect of larval exposure.

Identification, characterization and target gene analysis of testicular microRNAs in the oriental fruit fly Bactrocera dorsalis.

MicroRNAs (miRNAs) are small noncoding RNAs that regulate various diverse biological processes including insect spermatogenesis. The oriental fruit fly, Bactrocera dorsalis, is one of the most destructive horticultural pests in East Asia and the Pacific region. Although developmental miRNA profiles of B. dorsalis have enriched our knowledge, specific testicular miRNAs in this dipteran species are unexplored. In this study, we identified miRNAs from B. dorsalis testes by deep sequencing, which provided an overview of miRNA expression during spermatogenesis. Small RNA libraries were constructed from the testes of fully mature (FM), immature (IM) and middle-aged (MA) adult flies of B. dorsalis. Small RNA sequencing and data analysis revealed 172 known and 78 novel miRNAs amongst these libraries. Pairwise comparisons of libraries led to the identification of 24, 15 and 14 differentially expressed miRNAs in FM vs. IM, FM vs. MA and IM vs. MA insects, respectively. Using a bioinformatic approach, we predicted 124 target genes against the 13 most differentially expressed miRNAs. Furthermore, the expression patterns of six randomly selected miRNAs (from the 13 most differentially expressed miRNAs) and their putative target genes (from the 124 predicted target genes) were analysed in the testis of B. dorsalis by quantitative real-time PCR, which showed that out of six, four tested miRNAs-mRNAs had an inverse expression pattern and are probably co-regulated. This study is the first comparative profile of the miRNA transcriptome in three developmental stages of the testis, and provides a useful resource for further studies on the role of miRNAs in spermatogenesis in B. dorsalis.

iPhone and iPad Use in Orthopedic Surgery.

BACKGROUND: Thousands of healthcare mobile applications (apps) are available, and physicians are increasingly recognizing that mobile technology can improve their workflow and allow them to practice medicine in a better and/or more efficient manner. METHODS: This article highlights apps compatible with the iPhone and iPad and their utility to the busy orthopedic surgeon. RESULTS: Currently available apps address every aspect of healthcare: patient management, reference, education, and research. CONCLUSION: Key aspects of helpful apps include low cost (preferably free), a user-friendly interface, and simplicity.

Functional and Numerical Responses of Three Species of Predatory Phytoseiid Mites (Acari: Phytoseiidae) to Thrips flavidulus (Thysanoptera: Thripidae).

Phytoseiid mites are considered the most effective natural enemies of pest mites. They also have been shown to attack pest thrips. It is unknown, however, whether phytoseiid mites can reduce high densities of Thrips flavidulus (Bagnall). We addressed this question by the study of functional and numerical responses. The aim of this research was to evaluate the potential predation success of the adults of three predatory mites, Neoseiulus cucumeris (Oudemans), Neoseiulus barkeri (Hughes), and Euseius nicholsi (Ehara & Lee), against the first-instar of T. flavidulus in a climatic chamber at five different temperatures. The results showed that the functional responses of those predators reflected the Holling type II functional response and were density dependent and positively related to temperature. For the three predatory mites, predation and successful attack rates increased with increasing temperature up to 26°C, reducing afterward. Handling time had the opposite trend. Reproductive ability also increased with an increase in temperature and prey consumption.

Evaluación de la satisfacción del paciente con la atención recibida en un servicio de urgencias hospitalario y sus factores asociados / Patient evaluation of quality of emergency department care and associated factors

OBJETIVO: Conocer el grado de satisfacción global de los usuarios de un servicio de urgencias hospitalario (SUH) y analizar los factores que podían haber influido en la percepción de dicho grado de satisfacción. MÉTODO: Estudio de cohortes prospectivo basado en una encuesta a un grupo de pacientes menores de 65 años dados de alta desde el SUH durante marzo del 2011. Variable dependiente: "En términos de satisfacción, ¿cómo calificaría globalmente su experiencia en el servicio de urgencias?". Se registraron edad, sexo, día de la semana y nivel de triaje. La encuesta incluía la valoración del tiempo de espera; si era la primera vez que acudía al SUH; si se le había atendido con respeto y dignidad; si fue informado suficientemente; el trato del personal (administrativo, enfermería y médico); la información recibida de administrativos, enfermeros y médicos; y la limpieza, temperatura ambiente, luz y ruido del SUH. Se efectuó un análisis de regresión logística multinomial con las variables significativas. RESULTADOS: Se encuestaron 373 pacientes: 158 (42,4%) contestaron que su experiencia había sido totalmente satisfactoria, 187 (50,1%) satisfactoria y 28 (7,5%) no satisfactoria. Después del análisis multivariante, las variables que influían en una percepción no satisfactoria fueron la percepción de un tiempo de espera largo, un trato médico desconsiderado y la percepción de no reciber un trato respetuoso. CONCLUSIONES: En la población estudiada, el grado de satisfacción con la atención en urgencias, que suele ser elevado, está condicionado mayormente por la percepción del tiempo de espera, el trato médico recibido y un trato respetuoso (AU)

OBJECTIVE: To assess the level of patients' overall satisfaction with emergency department care and to analyze factors that may influence their perception of quality. METHOD: Prospective study of a cohort of patients under the age of 65 years who were discharged from the emergency department in March 2011. The patients' answers to the following question served as the dependent variable: How would you assess your overall satisfaction with your experience in our emergency department? Independent variables were age, sex, day of the week, and assigned triage level. The survey also contained questions asking for evaluation of wait time, if the emergency department visit was the patient's first, if the patient's dignity had been respected, if the patient felt adequately informed, how staff (administrative personnel, nurses, physicians) had behaved and if they gave sufficient information, and patients' impressions of the emergency department premises (cleanliness, temperature, lighting, noise level). Multinomial logistic regression was performed on significant variables. RESULTS: A total of 373 patients were surveyed; 158 (42.4%) evaluated their experience as completely satisfactory, 187(50.1%) as satisfactory, and 28 (7.5%) as unsatisfactory. After regression analysis, the variables found to be associated with perceived dissatisfaction were a prolonged wait time, inconsiderate treatment by a physician, and a feeling of not being respected. CONCLUSIONS: Level of satisfaction, which was high in general in this cohort, is influenced mainly by perception of wait time, the physician's attitude, and a sense of being respected (AU)

Antiparasitic efficacy of Artemisia absinthium, toltrazuril and amprolium against intestinal coccidiosis in goats.

Various anti-protozoal dugs have been popularly used in the treatment of goat coccidiosis; however, residual effects are well noticed in host animals. The present study was undertaken with the objective to evaluate the anticoccidial efficacy of Artemisia absinthium, as a safe alternative in comparison to two conventional anticoccidial drugs (toltrazuril and amprolium) in goats (Capra hircus) naturally infected with Eimeria spp. (>5,000 oocyst per gram of faeces). Goat kids (1-3 month old, 10 kg body weight) were randomly allocated into five groups (eight kids each). Group A was negative for coccidiosis and was retained as uninfected and untreated (negative control). Group B was infected and was kept untreated (positive control). Group C was given a single oral dose of toltrazuril (Baycox 5 %) at 20 mg kg(-1) BW (IM). Group D received amprolium soluble powder 20 w/w% at 50 mg kg(-1) BW 5 days daily. Group E was given a single dose of ethanolic extract of Artemisia absinthium at 2 g kg(-1) BW. Clinical signs, body-weight gain (BWG) and number of oocysts per gram faeces (OPG) were monitored daily for 30 days post treatment (DPT). The OPG was highly reduced as early as 7 DPT and there was a marked improvement in body weight gain (7 DPT) and faster clinical recovery (3-6 DPT) in the toltrazuril treated kids compared to amprolium and Artemisia absinthium treated groups (P ≤ 0.05). In Artemisia absinthium treated kids, the oocysts continued to be in faeces up to 28th day post treatment indicating that ethanolic extract of herb was less efficacious against caprine coccidiosis as compared to amprolium and toltrazuril. From the observations of the present study it can be concluded that control of goat coccidiosis through single treatment of toltrazuril was highly effective as compared to the other two treatments. However, integrated control involving pasture management, chemical and herbal control will be a more realistic and sustainable means of controlling coccidiosis in goats. Further studies at different doses and concentrations using different solvent preparations of the plant extract are recommended to arrive at a certain conclusion about the anti-coccidial efficacy of Artemisia absinthium, which has been reported to be highly effective against other parasites in ruminants.