An audit of inpatient insulin prescriptions - how error relates to information source.

Background: The risk of hospital insulin prescription errors in the UK has remained unchanged despite the adoption of several national initiatives. This audit was conducted to evaluate whether the prescription errors were related to the information source used. Aims: To determine what sources of information are used at the time of hospital admission of patients with diabetes to obtain details of their insulin regimen and how different sources relate to prescription errors. Method: We examined the clinical notes of 85 patients with diabetes and confirmed the insulin doses with the patient or the carer administering insulin. Results: Only 44 out of 85 (52%) patients or carers administering insulin recalled being asked about insulin; prescription errors were slightly lower in these patients but overall insulin prescription error remains at one in four. Conclusion: The persisting inpatient insulin error rate calls for a review of how the information on insulin regimen is collected and used by the healthcare services.

Prevalence and correlates of imposter syndrome and self-esteem among medical students at Jazan University, Saudi Arabia: A cross-sectional study.

Imposter syndrome (IS) and low self-esteem (SE) are common issues affecting medical students that can impact their well-being and development. This study aimed to assess the prevalence and factors associated with IS and SE among medical students at Jazan University, Saudi Arabia. In this cross-sectional study, 523 medical students in years 2-6 at Jazan University, Saudi Arabia, completed validated questionnaires on IS (Young Imposter Scale) and SE (Rosenberg Self-Esteem Scale). Sociodemographic factors were also collected. Descriptive statistics and logistic regression analyses were used to analyze IS and SE prevalence and correlates. Five hundred twenty-three students with a mean age of 22.09 ± 1.933 participated. The prevalence of low SE and positive IS was 17.6% and 24.3%, respectively. IS and SE had a significant negative correlation (p<0.001). Several sociodemographic factors were associated with increased IS, including 2nd and 4th-year students, forced study choice, and a grade point average (GPA) of 3.0-3.49 (P<0.05). Paternal education beyond high school was associated with lower IS (P<0.05). Logistic regression analyses confirmed that 2nd-year students had a 3.88 times higher odds ratio (OR) (95% confidence interval (CI); 2.19-6.88), and 4th-year students had a 2.37 times higher OR (95% CI; 1.40-4.02) of IS than other years. For SE, advanced academic years, forced study choice, 7+ hours of sleep, and a GPA above 3.5 were associated with higher levels (P<0.05). Negative self-appraisals were associated with lower SE, while positive attitudes were associated with higher SE (P<0.05). Our study reveals that IS and low SE are prevalent among Jazan University, Saudi Arabia, medical students. Therefore, intervention courses that address these issues in medical education at Jazan University, Saudi Arabia, may be necessary to support medical students' well-being and academic success.

Bacteria associated with ovine gut parasites Trichuris ovis and Haemonchus contortus.

An associated microbiome of any host helps it in different metabolic processes ranging from the decomposition of food to the maturation of gametes. Organisms with a parasitic mode of life, though present at nutritious sites inside their host, maintain their own microbiome. Nevertheless, the comprehensive characterization and functionality of microbiome in parasitic organisms remain understudied. We selected two nematode parasites of Kashmir Merino sheep viz;Haemonchus contortus and Trichuris ovis based on their higher prevalence, difference in mode of nutrition, habitation site and effect on host. The objective of the study was to explore the bacteria associated with these parasitic nematodes of sheep. We adopted a 16S rRNA metagenomic sequencing approach to estimate and compare the bacterial communities present in these two nematode species. Nematode parasites from Kashmir Merino sheep were identified morphologically and confirmed with DNA characterization. H. contortus was dominated by phylum Proteobacteria (57%), Firmicutes (25%), Bacteroidota (15%) and Actinobacteriota (3%). Conversely, T. ovis showed Proteobacteria (78%) followed by Firmicutes (8%), Bacteroidota (8%), Actinobacteriota (1%), Fusobacteriota (1%) and other phyla (4%). This study provides a comprehensive account of the microbiome composition of H. contortus and T. ovis, both of which are highly prevalent among Kashmir Merino sheep. Additionally, T. ovis exhibited a greater bacterial diversity compared to H. contortus. Notably, these nematodes were found to harbor certain pathogenic bacteria. This study can further be carried forward in gaining insights into the complex relationship between the microbiota of a parasite and its pathogenicity, reproductive potential and host microbiome modification.

Cobalt availability in the soil plant and animal food chain: a study under a peri-urban environment.

Cobalt metal is considered as an essential trace element for the animals. Present investigation was undertaken in the peri-urban area to analyze the cobalt availability in animal food chain by using different indices. Cow, buffalo and sheep samples along with forage and soil samples were collected from the three different sites of District Jhang and analyzed through atomic absorption spectrophotometer. Cobalt values differed in soil samples as 0.315-0.535 mg/kg, forages as 0.127-0.333 mg/kg and animal samples as 0.364-0.504 mg/kg. Analyzed cobalt concentration in soil, forage and animal samples was found to be deficient in concentration with respect to standard limits. Soil showed the minimum cobalt level in Z. mays while maximum concentration was examined in the forage C. decidua samples. All indices examined in this study has values lesser than 1, representing the safer limits of the cobalt concentration in these samples. Enrichment factor (0.071-0.161 mg/kg) showed the highly deficient amount of cobalt enrichment in this area. Bio-concentration factor (0.392-0.883) and pollution load index (0.035-0.059 mg/kg) values were also lesser than 1 explains that plant and soil samples are not contaminated with cobalt metal. The daily intake and health risk index ranged from 0.00019-0.00064 mg/kg/day and 0.0044-0.0150 mg/kg/day respectively. Among the animals, cobalt availability was maximum (0.0150 mg/kg/day) in the buffaloes that grazed on the C. decidua fodder. Results of this study concluded that cobalt containing fertilizers must be applied on the soil and forages. Animal feed derived from the cobalt containing supplements are supplied to the animals, to fulfill the nutritional requirements of livestock.

Trichostrongylosis: a zoonotic disease of small ruminants.

In the present world a significant threat to human health is posed by zoonotic diseases. Helminth parasites of ruminants are one of the most common zoonotic organisms on the planet. Among them, trichostrongylid nematodes of ruminants, found worldwide, parasitize humans in different parts of the world with varying rates of incidence, particularly among rural and tribal communities with poor hygiene, pastoral livelihood and poor access to health services. In the Trichostrongyloidea superfamily, Haemonchus contortus, Teladorsagia circumcincta, Marshallagia marshalli, Nematodirus abnormalis and Trichostrongylus spp. are zoonotic in nature. Species of the genus Trichostrongylus are the most prevalent gastrointestinal nematode parasites of ruminants that transmit to humans. This parasite is prevalent in pastoral communities around the world and causes gastrointestinal complications with hypereosinophilia which is typically treated with anthelmintic therapy. The scientific literature from 1938 to 2022 revealed the occasional incidence of trichostrongylosis throughout the world with abdominal complications and hypereosinophilia as the predominant manifestation in humans. The primary means of transmission of Trichostrongylus to humans was found to be close contact with small ruminants and food contaminated by their faeces. Studies revealed that conventional stool examination methods such as formalin-ethyl acetate concentration or Willi's technique combined with polymerase chain reaction-based approaches are important for the accurate diagnosis of human trichostrongylosis. This review further found that interleukin 33, immunoglobulin E, immunoglobulin G1, immunoglobulin G2, immunoglobulin M, histamine, leukotriene C4, 6-keto prostaglandin F1α, and thromboxane B2 are vital in the fight against Trichostrongylus infection with mast cells playing a key role. This review focuses on the prevalence, pathogenicity and immunological aspects of Trichostrongylus spp. in humans.

Arthroscopic Anatomic Glenoid Reconstruction in the Setting of a Failed Latarjet Using Distal Tibial Allograft.

Treatment of traumatic anterior glenohumeral dislocation has evolved over the years in terms of surgical approaches and methods of repair. Recurrence of instability following surgical repair remains challenging with conventional methods of open reconstruction. We describe the utilization of arthroscopic anatomic glenoid reconstruction using a distal tibial allograft after a failed Latarjet procedure. Preoperative and operative methodology are described with relevant imaging investigations and a detailed intraoperative arthroscopic technique.

Dysplasia Epiphysealis Hemimelica/Trevor Disease: Report of a Lesion Solely Involving the Lunate Bone: A Case Report.

CASE: We describe the case of a dysplasia epiphysealis hemimelica (DEH) lesion affecting uniquely the lunate bone in a 16-year-old boy causing pain, stiffness, and decreased range of motion. Surgical excision was performed, leading to resolution of primary symptoms with residual limitations in terminal wrist extension. CONCLUSIONS: From our review of the literature, we believe this case to be the first report of a DEH lesion affecting solely the lunate bone. Although conservative and surgical management have both been described with DEH cases, we report a positive outcome following the excision of a symptomatic lesion.

Hip Arthroscopy for Femoral Acetabular Impingement: A Bird's-Eye/En Face Perspective With Ultrasound Guidance and 3-Dimensional Hip Printing.

Femoral acetabular impingement is a common hip disorder that may prove debilitating to many patients. Surgical management is indicated by way of hip arthroscopy for impinging CAM and pincer acetabular lesions. Traditionally, fluoroscopy has been used for the intraoperative assessment of bony resection; however, many disadvantages include radiation risks, equipment demands, and more. With ultrasound-guided arthroscopy, we describe the use of 1:1 3-dimensional hip printed models through various visual perspectives of impinging lesions. Given the low cost of 3-dimensional hip printing, lack of radiation exposure, and tactile multiangular views, we propose a safer and more reproducible intraoperative technique to conventional fluoroscopy to achieve better resection and outcomes after femoral acetabular impingement surgery.

Probability-driven 3D pharmacophore mapping of antimycobacterial potential of hybrid molecules combining phenylcarbamoyloxy and N-arylpiperazine fragments.

The current study examines in silico characterization of the structure-inhibitory potency for a set of phenylcarbamic acid derivatives containing an N-arylpiperazine scaffold, considering the electronic, steric and lipophilic properties. The main objective of the ligand-based modelling was the systematic study of classical comparative molecular field analysis (CoMFA)/comparative molecular surface analysis (CoMSA) performance for the modelling of in vitro efficiency observed for these phenylcarbamates, revealing their inhibitory activities against a virulent Mycobacterium tuberculosis H37Rv strain. We compared the findings of efficiency modelling produced by a standard 3D methodology (CoMFA) and its neural counterparts (CoMSA) regarding multiple training/test subsets and variables used. Moreover, systematic space inspection, splitting values into the analysed training/test subsets, was performed to monitor statistical estimator performance while mapping the probability-driven pharmacophore pattern. Consequently, a 'pseudo-consensus' 3D-quantitative structure-activity relationship (3D-QSAR) approach was applied to retrieve an 'average' pharmacophore hypothesis by the investigation of the most densely populated training/test subpopulations to specify the potentially important factors contributing to the inhibitory activity of phenylcarbamic acid analogues. In addition, examination of descriptor-based similarity with a principal component analysis (PCA) procedure was employed to visualize noticeable variations in the performance of these molecules with respect to their structure and activity profiles.

A micellar cisplatin prodrug simultaneously eliminates both cancer cells and cancer stem cells in lung cancer.

Platinum-based chemotherapy as first-line treatment for lung cancers encounters insufficient selectivity, severe side effects and drug resistance in clinics. In this study, we developed an amphiphilic prodrug of cisplatin-poly(ethylene glycol)-block-polycaprolactone and demonstrated that the prodrug formed micellar nanoparticles, NPPt(IV), with an average diameter of ∼100 nm. NPPt(IV) released platinum in response to the intracellular acidic and reductive environment, and in turn induced significant anti-proliferative activity in lung cancer cells. More importantly, NPPt(IV) exhibited a prominent inhibitory effect on CD133+ lung cancer stem cells (CSCs) and suppressed tumor growth in vivo. Unlike cisplatin treatment which eventually enriches CSCs, NPPt(IV) treatment prevents the accumulation of CD133+ lung CSCs in tumors. Therefore, NPPt(IV) simutaneously targeting CSCs and non-CSCs might represent a superior strategy to improve conventional anticancer therapy directed predominantly to tumor bulk populations.

Conformational control of the bacterial Clp protease by natural product antibiotics.

Covering: up to 2017The bacterial Clp protease is a highly conserved and structurally versatile machine. It has gained a lot of recognition during the last decade as a novel antibacterial drug target with an unprecedented mechanism of action. Due to its complexity, there are distinct means of interfering with its natural functions and several compounds targeting this machine have been identified. In this review, we summarize the current state of knowledge about natural products deregulating Clp proteolysis, a crucial and delicate process within the cell. Among those, acyldepsipeptide antibiotics of the ADEP class (ADEPs) are characterized best. The molecular mechanism of ADEP-mediated deregulation sheds light on the inner workings of the Clp protease.

Depth versus subdural temporal electrodes revisited: Impact on surgical outcome after resective surgery for epilepsy.

OBJECTIVE: To study retrospectively the impact of electrode modality (subdural or depth electrodes) during presurgical assessment on surgical outcome after temporal lobectomy. METHODS: The study included 17 patients assessed with depth electrodes and 57 with bitemporal subdural strips. RESULTS: MRI showed a larger proportion of bilateral pathology in patients undergoing depth recordings (29.41% versus 3.5%, p=0.00069). Among the operated patients, those undergoing depth electrode recordings showed better outcome at one year after surgery (11/12 versus 22/33; p=0.046). This difference disappears at longest follow up (10/12 versus 22/33; p=0.138). Moreover, the probability of undergoing surgery and having good outcome after assessment with intracranial recordings is higher for the depth electrode group at one-year follow up (11/17 versus 22/57; p=0.029) but statistical differences decrease to a trend for the longest follow up (10/17 versus 22/57; p=0.069). No other statistical differences were noted between subdural and depth electrodes. Depth electrodes showed lower complication rates than subdural electrodes. CONCLUSION: Both depth and subdural electrodes are effective for presurgical assessment of temporal lobe epilepsy. SIGNIFICANCE: Assessment with depth electrodes is associated with slightly increased likelihood of surgery and marginally better surgical outcome at one year follow up which disappears for longer follow up periods. Initial assessment with depth electrodes would have avoided a second implantation in 15% of patients.

Moderated Mediation Model of Interrelations between Workplace Romance, Wellbeing, and Employee Performance.

In this study, first we examined the effect of workplace romance on employee job performance, and the mediatory role of psychological wellbeing in the relationship between workplace romance and employee performance. Then we tested the moderating effects of gender and workplace romance type - lateral or hierarchical - on the indirect effect of workplace romance on employee performance. Based on a survey of 311 doctors from five government teaching hospitals in Pakistan, we used structural equation modeling and bootstrapping to test these relationships. This study reveals that psychological wellbeing significantly fully mediates the positive relationship between workplace romance and job performance. Moreover, multi-group analysis shows that gender moderates the indirect effect of workplace romance on employee performance, where the indirect effect of workplace romance on employee performance is stronger for male participants. This study carries important implications, particularly for the policy makers and managers of healthcare sector organizations.

Endoscopic lumbar discectomy under local anesthesia may be an alternative to microdiscectomy: A single centre's experience using the far lateral approach.

OBJECTIVES: Since the turn of the century, minimally invasive surgery has become increasingly widespread. Discectomy surgery has evolved from wide open to microscopic and now endoscopic. This study aims to demonstrate that transforaminal endoscopic discectomy is an alternative and safe approach for degenerative disk surgery. PATIENTS AND METHODS: Two year retrospective assessments of patients who underwent transforaminal endoscopic discectomy at a tertiary neurosurgical center in the United Kingdom by a single surgeon. Under strict confidentiality, data was collected from online patient data and PACS systems. Patient feedback was achieved using phone call follow up and clinic appointments. Standard statistical analysis was performed. RESULTS: 201 patients had endoscopic discectomy and the mean age was 41 years. Male:female ratio was 1.3:1.0. Mean time of onset of symptoms was 5.5 months and the most common level was L4/5 (53%). All endoscopic discectomies were performed under local anesthesia. Theater time was on average 110 min. 10 patients were lost to follow up. 95% of patients were discharged within 7h post operatively. Visual acuity score of the pain dropped from an average of 7/10 pre-operatively to 0-1/10 in 95% of patients two weeks post operatively. 87% patients went back to their normal daily activities within two weeks. There were no cases of CSF leak, hematoma formation or wound infection. 1% of patients developed a nerve root injury. 6% of patients had recurrent herniation and require microdiscectomy. CONCLUSION: Endoscopic discectomy can be an alternative approach to microdiscectomy. While it can take more expertise to perform endoscopic discectomy, our data shows that the far lateral endoscopic discectomy using the TESSYS technique has comparable outcomes to microdiscectomy.

Neonatal umbilical cord myiasis in New Jersey.

Human myiasis is a rare condition. It is more common in tropical regions. Umbilical cord myiasis has not previously been reported from a temperate climate, for example, New Jersey. We report a 9-day-old infant with umbilical cord myiasis. The maggots were identified by the entomologist as the larvae of Sarcophagidae, more commonly known as flesh flies.

Modern management of a patent foramen ovale.

A patent foramen ovale (PFO) has been associated with medical conditions such as cryptogenic stroke, migraine with aura, and decompression illness. Whether closure of the PFO has clinical benefit has been suggested from registry studies, but not yet confirmed in multiple randomized trials. Methods of diagnosis of a PFO and a summary of the current evidence for treatment is presented and discussed as a guide to patient-centred decision-making.

Magnitude and direction of mechanical stress at the osseointegrated interface of the microthread implant.

BACKGROUND: The mechanism by which the microthread implant preserves peri-implant crestal bone is not known. The objective of this research is to assess the effect of microthreads on the magnitude and direction of the stress at the bone-implant interface using finite element analysis modeling. METHODS: Three-dimensional finite element models representing the microthreaded implant (microthread model) and smooth surface implant (smooth model) installed in the mandibular premolar region were created based on microscopic and computed tomography images. The mesh size was determined based on convergence tests. Average maximum bite force of adults was used with four loading angles on the occlusal surface of the prosthesis. RESULTS: Regardless of the loading angle, principal stresses at the bone-implant interface of the microthread model were always perpendicular to the lower flank of each microthread. In the smooth model, stresses were affected by the loading angle and directed obliquely to the smooth interface, resulting in higher shear stress. The interfacial stresses decreased gradually in the apical direction in both models but with wavy pattern in the microthread model and smooth curve for the smooth model. Although peak principal stress values were higher around the microthread implant, peri-implant bone volume exhibiting a high strain level >4,000 µ was smaller around the microthread implant compared to the smooth implant. CONCLUSION: Stress-transferring mechanism at the bone-implant interface characterized by the direction and profile of interfacial stresses, which leads to more compressive and less shear stress, may clarify the biomechanical aspect of microthread dental implants.

A comparative study of South Asian and non-Asian referrals to an eating disorders service in Leicester, UK.

Literature on eating disorders (EDs) among South Asian people in Britain is limited. In an extension of an earlier study, referrals to the Leicester Adult Eating Disorders Service were examined between 1991 and 2005. All South-Asians presenting to the service were compared on age, gender and diagnosis with non-Asians. Female Asian patients diagnosed as bulimia nervosa and ED not otherwise specified were compared on a larger number of variables with the same number of non-Asian patients matched for diagnosis. As there were only six Asian patients with anorexia nervosa they were excluded from this comparison. Only 4.5% of female patients were Asian, as opposed to 13.8% of the local young female population in the most recent UK census. Overall, Asian women were significantly younger than the non-Asians but did not differ significantly with regard to clinical features or treatment variables. Asians are under-represented amongst women presenting to the service. The explanation for this remains uncertain. Overall, Asian sufferers who reach secondary specialist services closely resemble non-Asian patients.

Metformin: safety in cardiac patients.

Metformin is a biguanide, insulin sensitiser that reduces blood sugar levels. There are concerns about the risk of lactic acidosis in patients receiving metformin who have procedures requiring iodinated contrast, and in those with renal impairment or heart failure. The data on which these concerns are based are reviewed, with the conclusion that metformin treatment is rarely to blame for lactic acidosis. A generic policy of stopping metformin 48 h before and 48 h after the procedure in all patients is counterintuitive, lacks any evidence base and does not conform to the principles of best practice. In patients with heart failure, although the underlying condition can predispose to lactic acidosis, existing evidence suggests that metformin use is associated with improved outcome rather than increased risk.