Industry Payments to US Physicians by Specialty and Product Type.

This study examines the distribution of payments within and across specialties and the medical products associated with the largest total payments.

Assessment of vitamin status; A, E and D in Egyptian neonates with IUGR: a cross sectional study.

BACKGROUND: Neonates with intrauterine growth retardation (IUGR) may present with fatal complications and permanent serious consequences. Vitamin status may influence fetal development. In this study we assessed vitamin A, E and D concentrations in umbilical cord blood in newborns with IUGR. METHODS: Maternal data were obtained. Neonatal assessment included; age of gestation calculated from last menstrual period, Ultrasound (U/S), new Ballard, Apgar scores and anthropometric measurements including; Head circumference, length and weight. WHO growth percentile curves were used. Vitamin A, E and D in cord blood samples were measured by high performance liquid chromatography (HPLC) and ELISA consecutively. RESULTS: A total of 86 full term newborns were enrolled in this study, 42 (48.8%) with IUGR with gestational age (33.59 ± 1.20) week by U/S and 44 (51.2%) appropriate for gestational age neonates with gestational age (38.70 ± 1.50). Ballard and Apgar scores (p < 0.05) and Z scores for weight, length and head circumference (p < 0.001) at birth were significantly lower in neonates with Intrauterine growth retardation (IUGR) than appropriate for gestational age (AGA) neonates. The levels of Vitamin A, E and D were significantly lower in the IUGR group than the AGA (p < 0.05) for all. Significant positive correlations of weight with vitamin A, and E cord blood levels were found (p < 0.05), while length was significantly positively correlated only with vitamin A (p < 0.05). Head circumference showed significant positive correlations with the three vitamins (p < 0.05) for all. CONCLUSION: Neonates with IUGR had significantly lower levels of Vitamin A, E and D than AGA neonates. Significant positive correlations of weight with vitamin A, and E cord blood levels was detected, while neonatal length was associated only with vitamin A level. The present study highlights the significance of nutritional policies for inhibiting deficiency of these vitamins during pregnancy and childhood.

In silico assessment of diterpenes as potential inhibitors of SARS-COV-2 main protease.

Aim: We aimed to investigate the potential inhibitory effects of diterpenes on SARS-CoV-2 main protease (Mpro). Materials & methods: We performed a virtual screening of diterpenoids against Mpro using molecular docking, molecular dynamics simulation and absorption, distribution, metabolism and excretion) analysis. Results: Some tested compounds followed Lipinski's rule and showed drug-like properties. Some diterpenoids possessed remarkable binding affinities with SARS-CoV-2 Mpro and drug-like pharmacokinetic properties. Three derivatives exhibited structural deviations lower than 1 Å. Conclusion: The findings of the study suggest that some of the diterpenes could be candidates as potential inhibitors for Mpro of SARS-CoV-2.

In vitro and In silico assessment of antischistosomal activities of ethanolic extract of Cornulacamonacantha.

Schistosomiasis is the second most prevailing parasitic disease worldwide. Although praziquantel is considered an effective drug in the treatment against schistosomiasis to some extent, there is an emerging drug resistance that widely recorded. Therefore, there is an urgent need to develop effective and safe anti-schistosomal drugs. In this study, Cornulaca monacantha (C. monacantha), a sub-saharan plant, was extracted using aqueous ethanol and characterized by High-Performance Liquid Chromatography (HPLC). Major constituents of the extract are belonging to flavonoids, tannins and phenolic glycosides. Worms' viability and surface morphology of Schistosoma mansoni (S. mansoni) adult worms treated with the extract were assessed using in vitro viability assay, Scanning Electron Microscopy (SEM), and histological examination. The extract (80-350 µg/ml) reduced viability percentage of worms by 40-60% and caused degeneration of both oral and ventral suckers, tegumental, sub-tegumental and muscular damage. Molecular docking approach was utilized to assess the binding affinities of the extracted compounds with S. mansoni alpha-carbonic anhydrase (SmCA), an essential tegument protein. Pharmacokinetic analysis using SwissADME showed that 7 compounds have high drug similarity. This study confirms the in vitro schistomicidal activity of C. monacantha extract against S. mansoni adult worms and suggests potential SmCA inhibition.

Value of Surgical and Nonsurgical Treatment for Sleep Apnea: A Closer Look at Health Care Utilization.

OBJECTIVE: To determine how surgery, continuous positive airway pressure (CPAP), and no treatment impact health care utilization in patients who have obstructive sleep apnea (OSA). STUDY DESIGN: This is a retrospective cohort study of patients between the ages of 18 and 65 that were diagnosed with OSA (9th International Classification of Diseases) from January 2007 to December 2015. Data were collected over 2 years, and prediction models were generated to evaluate trends over time. SETTING: A population-based study using real-world data and insurance databases. METHODS: A total of 4,978,649 participants were identified, all with at least 25 months of continuous enrollment. Patients with previous soft tissue procedures not approved for OSA (nasal surgery), or without continuous insurance coverage were excluded. A total of 18,050 patients underwent surgery, 1,054,578 were untreated, and 799,370 received CPAP. IBM Marketscan Research database was utilized to describe patient-specific clinical utilization, and expenditures, across outpatient, and inpatient services, and medication prescriptions. RESULTS: When the cost of the intervention was eliminated in the 2-year follow-up, the monthly payments of group 1 (surgery) were significantly less than group 3 (CPAP) in overall, inpatient, outpatient, and pharmaceutical payments (p < .001). The surgery group was associated with less cumulative payments compared to the other 2 groups when the cost of the intervention (CPAP or surgery) was eliminated in all comorbidities and age groups. CONCLUSION: Treating OSA with surgery can lessen overall health care utilization compared to no treatment and CPAP.

Health risk assessment of organochlorine pesticide residues in edible tissue of seafood.

Fish is one of the most valuable foods with high-quality animal protein. However, aquaculture, or ingesting contaminated food, allows organochlorine pesticides (OCPs) to enter the fish's body, and therefore, it negatively impacted public health. One-hundred and twenty random samples of Clupea harengus (C. harengus), Mugil cephalus (M. cephalus), Sardinella aurita (S. aurita), Oreochromis niloticus (O. niloticus), Neptunus pelagicus (N. pelagicus) and Sepia savigngi (S. savigngi) (n = 20 each) were collected from local markets in Mansoura city, Egypt. Samples were checked to see whether any residues of OCPs with the application of risk assessment due to their consumption by Mansoura citizens. The findings indicated that summation hexachlorocyclohexane (∑HCH) in examined seafood samples ranged from 0.27 ± 0.13 in N. pelagicus to 61.61 ± 52.03 µg.kg-1 in S. aurita. Also, the γ-HCH isomer was considered the more prominent among isomers. Hexachlorobenzene (HCB) was found in five different species, with mean values of 2.03 ± 1.85, 1.5.7 ± 1.17, 0.94 ± 0.87, 0.35 ± 0.06, and 0.18 ± 0.06 µg.kg-1 in C. harengus, S. aurita, M. cephlaus, O. niloticus, and S. savigngi. Moreover, summation of Heptachlors (∑HPTs) was 10.19 ± 7.63, 1.27 ± 0.26, 2.58 ± 0.11, 0.95 ± 0.12, 0.21 ± 0.11 and 0.32 ± 0.03 µg.kg-1 of wet weight in examined C. harengus, M. cephlaus, S. aurita, O. niloticus, N. pelagicus, and S. savigngi. Aldrin and dieldrin residues were 3.75 ± 1.31 and 4.86 ± 1.33 µg.kg-1 in C. harengu, meanwhile they were 1.61 ± 0.77 and 0.78 ± 0.04 µg.kg-1in M. cephalus. Dichlorodiphenyldichloroethylene (pp-DDE) was dominant in all examined species within different concentrations 5.08 ± 4.12, 0.98 ± 0.10, 3.07 ± 0.91, 0.93 ± 0.27, 0.08 ± 0.01 and 0.35 ± 0.02 µg.kg-1 in C. harengus, M. cephlaus, S. aurita, O. niloticus, N. pelagicus and S. savigngi, respectively. We concluded that all examined seafood samples were lower than the recommended maximum residue limit. Also, the estimated daily intake was less than the permitted daily intake. Non-carcinogenic indices of target hazard quotient and hazard index for OCPs in all examined species were less than 1.

A Novel Cost-Effective Simulation Model for Continuous Curvilinear Capsulorhexis.

Introduction: We describe and validate a low-cost simulation model for practicing anterior lens capsule continuous curvilinear capsulorhexis (CCC). Methods: A simulation model for CCC was developed from widely available low-cost materials. Ophthalmologists attending the annual scientific meeting of the Research Institute of Ophthalmology, Giza, Egypt, were asked to perform a five CCC model task and then anonymously answer a questionnaire that assessed the realism and training utility of the model using a five-point Likert scale (1 = unacceptable, 2 = poor, 3 = acceptable, 4 = favorable and 5 = excellent). Results: Twenty-seven ophthalmologists completed the task and the anonymous questionnaire. Overall, participants felt that the model simulated CCC step in cataract surgery well (mean: 3.5) and was comparable to other kinds of CCC simulation models (mean: 3.3). The model scored highly for its overall educational value (mean: 4.00) and for enlarging a small CCC (mean:3.7), while the feasibility of this model in practicing the management of a runaway leading edge of CCC scored 2.9. Conclusion: This model may provide an alternative method for training for CCC and other anterior lens capsule-related maneuvers. This option may be particularly helpful for residency training programs with limited access to virtual reality simulators or commercially available synthetic eye models.

Racial Disparity in Flu Vaccine Uptake Among Asian American Individuals: A National Health Interview Survey Study.

Vaccination coverage rates across Asian American subpopulations with atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus is not well-studied. We used data from the National Health Interview Survey (NHIS) from 2006 to 2018 and included participants with a history of ASCVD or diabetes. Vaccination coverage in White were compared with Chinese, Asian Indian, Filipino, and "other Asian" (Japanese, Korean, and Vietnamese) adults using univariable and multivariable logistic regression models. We included 50,839 participants, mean age 62.7 ± 0.1 years, 46.3% women, 89.1% US-born. Filipino (59%) and Asian Indian (56%) adults were less likely to receive influenza vaccine than "other Asians" (66%), Chinese (65%), and White (60%) participants (P < 0.001). In multivariable adjusted models, Chinese (OR = 1.66, 1.02-2.69), Asian Indian (OR = 1.50, 1.07-2.10), and "other Asian" ethnicity (OR = 1.81, 1.38-2.36) were associated with higher odds of receiving influenza vaccination compared with White. Influenza vaccine coverage remains suboptimal across all studied races/ethnicities.

Gender Differences in Smoking Attitude among Saudi Medical Students.

BACKGROUND: Smoking is a growing public health problem throughout the world. However, the attitude of males and females toward smoking may differ. Therefore, this study examines gender differences in smoking behavior and attitude among Saudi medical students. METHODS: From January 2020 to August 2020, a snowball cross-sectional online survey was conducted in five major regions of Saudi Arabia. Medical students (18 years or older) were invited to respond to the questionnaire. RESULTS: Out of the 421 respondents, 255 (60.6%) were female, 243 (57.7%) were between 18 and-24-year-old, and 164 (39%) were from the Eastern Province. The overall prevalence of smoking was 25.4% and was higher among males than females [(44% and 13.3%, respectively), P < 0.001]. However, there was no significant difference in the mean score of the overall attitude towards smoking between males and females [(3.02±0.44 and 3.00±0.34), respectively, P=0.64]. However, more female students believed e-cigarettes were harmful to health than male students [(4.19±1.04 and 4.45±0.9), respectively, P=0.002]. CONCLUSION: The study showed that male students smoke more than female students, and there were no significant differences in the overall attitudes score towards smoking. Therefore, campaigns are needed to decrease smoking rate, especially among male students.

Assessment of Seroprevalence and Associated Risk Factors for Anaplasmosis in Camelus dromedarius.

(1) Background: Anaplasmosis is an infectious disease in camels caused by an obligate intracellular bacterium that is transmitted by ticks. (2) Methods: A cross-sectional study was conducted during 2020 to study the seroprevalence of Anaplasma spp. among Camelus dromedarius in three governorates in Egypt and assess the associated risk factors. Serum samples from 365 camels were examined by a competitive enzyme-linked immunosorbent assay (cELISA) test. (3) Results: Overall, the seroprevalence of anaplasmosis among camels was 18.6%. Multivariable logistic regression was performed, and it was discovered that tick infestation, application of acaricides, grooming practice and body condition were potential risk factors for Anaplasma spp. infection (odds ratio > 1) in dromedary camels. In contrast, the locality in which the camels lived and their age were not significant effects with regard to the occurrence of anaplasmosis. (4) Conclusions: The current findings suggest that improvement of protective measures to limit the effects of the identified risk factors can help to reduce the spread of anaplasmosis among camels in Egypt.

An all-solid-state potentiometric sensor modified with multi-walled carbon nanotubes (MWCNTs) for silicate assessment and water-quality testing.

A simple and cost-effective approach is proposed for silicate ion determination. The approach is based on designing an all-solid-state potentiometric sensor. The plasticized polyvinyl chloride (PVC) membrane sensor is based on the ion-association complex [Ni(bphen)3]2+[SiO3]2- as a sensory recognition material. The sensor is modified with multi-walled carbon nanotubes (MWCNTs) as an ion-to-electron transducer material. The performance characteristics of the new silicate-selective electrode were evaluated using a potentiometric water-layer test, potentiometric measurements, impedance spectroscopy, and current-reversal chronopotentiometry. The developed electrodes exhibited a low detection limit (0.11 µg mL-1) over a wide linear range (4.0 × 10-6 to 1.0 × 10-3 M) and near-Nernstian sensitivity (slope = -28.1 ± 1.4 mV per decade). They presented a very short response time (<5 s) over the pH range 6-12 and provided acceptable reliability, ease of design and miniaturization, and high potential stability, in addition to good accuracy and precision. The sensors exhibited enhanced selectivity for silicate over many common interfering anions, such as SO42-, NO3-, CH3COO-, CO32-, Cl-, S2-, and PO43-. These results could qualify the developed sensor to be used in a successful way for the trace determination of silicate ions in different matrices. The developed method was successfully applied to the potentiometric detection of silicate in different pre-packaged bottled drinking water samples.

Integrated all-solid-state sulfite sensors modified with two different ion-to-electron transducers: rapid assessment of sulfite in beverages.

An integrated all-solid-state screen-printed ion-selective potentiometric sensor for rapid assessment of sulfite ion in beverages, based on analytical transduction, is described. The constructed potentiometric cell incorporates a polymeric membrane sulfite ion-selective electrode based on cobalt(ii) phthalocyanine (CoPC) as a recognition material and an Ag/AgCl reference electrode with a polyvinyl butyral reference membrane. Two different solid-contact transducers, namely multi-walled carbon nanotubes (MWCNTs) and polyaniline (PANI) were used for a comparative study. The presented sensors exhibited a rapid Nernst response across the concentration ranges from 2.0 × 10-6 to 2.3 × 10-3 M and from 5.0 × 10-6 to 2.3 × 10-3 M with detection limits equal to 1.1 × 10-6 M and 1.5 × 10-6 M for sensors based on MWCNTs and PANI, respectively. The proposed sensors manifested high selectivity and sensitivity, enhanced stability and low cost that provides a wide number of potential applications for food analysis. Good performance characteristics were obtained for the proposed method after applying the validation requirements. Method precision, accuracy, bias, trueness, repeatability, reproducibility, and uncertainty are examined. These analytical capabilities support the rapid and direct determination of sulfite in different beverage samples. The analytical results were verified and compared with the standard iodometric method.

Correction: Integrated all-solid-state sulfite sensors modified with two different ion-to-electron transducers: rapid assessment of sulfite in beverages.

[This corrects the article DOI: 10.1039/D0RA09903A.].

Novel Solid-State Potentiometric Sensors Using Polyaniline (PANI) as A Solid-Contact Transducer for Flucarbazone Herbicide Assessment.

Novel potentiometric solid-contact ion-selective electrodes (SC/ISEs) based on molecularly imprinted polymers (MIPs) as sensory carriers (MIP/PANI/ISE) were prepared and characterized as potentiometric sensors for flucarbazone herbicide anion. However, aliquat S 336 was also studied as a charged carrier in the fabrication of Aliquat/PANI/ISEs for flucarbazone monitoring. The polyaniline (PANI) film was inserted between the ion-sensing membrane (ISM) and the electronic conductor glassy carbon substrate (GC). The sensors showed a noticeable response towards flucarbazone anions with slopes of -45.5 ± 1.3 (r2 = 0.9998) and -56.3 ± 1.5 (r2 = 0.9977) mV/decade over the range of 10-2-10-5, 10-2-10-4 M and detection limits of 5.8 × 10-6 and 8.5 × 10-6 M for MIP/PANI/ISE and Aliguat/PANI/ISE, respectively. The selectivity and long-term potential stability of all presented ISEs were investigated. The short-term potential and electrode capacitances were studied and evaluated using chronopotentiometry and electrochemical impedance spectrometry (EIS). The proposed ISEs were introduced for the direct measurement of flucarbazone herbicide in different soil samples sprayed with flucarbazone herbicide. The results agree well with the results obtained using the standard liquid chromatographic method (HPLC).

Incidence, Management, and Outcomes of Chylothorax after Lung Transplantation: A Single-center Experience.

Background The objective of this study was to determine the incidence and outcomes of chylothorax after lung transplantation. Methods We conducted a retrospective review of our institutional lung transplant registry of 504 adult transplantations done from 2001 to 2015 and identified seven patients (1.38%) with chylothorax. Electronic health records were then analyzed to determine demographics, indications for surgery, management, and outcomes. Survival curves were plotted using the Kaplan-Meier method. Results Chylothorax presented in the first week in four (62.5%) patients, and approximately one month later in the remaining three. Nonsurgical management was initially attempted in all patients and succeeded in three (42.9%). Elective surgical ligation of the thoracic duct (LTD) was successful in two (66.7%) out of three patients in whom it was performed. One patient required emergent reoperation for clamshell thoracotomy dehiscence from severe chylothorax. Thoracic duct embolization was attempted but unsuccessful in two patients. Subsequently, one of these patients received a peritoneal-venous shunt and the other underwent LTD. Chylothorax permanently resolved in six patients (85.7%). There were no mortalities directly related to chylothorax. The median time to resolution was 11 days (range: 7-60). The mean survival in months for chylothorax patients was 29.2 (SE 3.1) and 78.2 (SE 2.9) for the remaining patients (p = 0.37). The median survival was not reached for the chylothorax group and was 71.8 months (95% CI: 58.0-83.9) for the rest. Conclusion Chylothorax is rare after lung transplantation but can lead to major comorbidities and prolonged hospital stay. In our experience, nonsurgical management was successful in up to 40% of patients. LTD should be considered in those who fail conservative management.

Benefits of an Android Based Tablet Application in Primary Screening for Eye Diseases in a Rural Population, India.

To investigate the effectiveness, efficiency and cost gains in collecting patient eye health information from remote rural villages of India by trained field investigators through an Android Based Tablet Application namely 'Sankara Electronic Remote Vision Information System (SERVIS)". During January and March 2016, a population based cross-sectional study was conducted in three Indian states employing SERVIS and manual method. The SERVIS application has a 48-items survey instrument programed into the application. Data on 281 individuals were collected for each of these methods as part of screening. The demographic details of individuals between both screening methods were comparable (P>0.05). The mean time (in minutes) to screen an individual by SERVIS was significantly less when compared to manual method (6.57±1.46 versus 11.93±1.53) (P<0.0001). The efficiency of SERVIS in screening was significantly evident as 26% (n = 73) of the patients screened have been referred to campsite and 69.8% (n = 51) of those referred were visited the campsite for a detailed eye examination by an ophthalmologist. The cost of screening through SERVIS is significantly less when compared to manual method; INR 7,633 (USD 113.9) Versus INR 24,780 (USD 370). SERVIS is an effective and efficient tool in terms of patients' referral conversion to the camp site leading to timely detection of potential blinding eye conditions and their appropriate treatment. This ensures timely prevention of avoidable blindness and visual impairment. In addition, the storage and access of eye health epidemiological quality data is helpful to plan appropriate blindness prevention initiatives in rural India.

Computed Tomography Assessment of Hepatic Metastases of Breast Cancer with Revised Response Evaluation Criteria in Solid Tumors (RECIST) Criteria (Version 1.1): Inter-Observer Agreement.

BACKGROUND: To assess inter-observer agreement of revised RECIST criteria (version 1.1) for computed tomography assessment of hepatic metastases of breast cancer. MATERIAL/METHODS: A prospective study was conducted in 28 female patients with breast cancer and with at least one measurable metastatic lesion in the liver that was treated with 3 cycles of anthracycline-based chemotherapy. All patients underwent computed tomography of the abdomen with 64-row multi- detector CT at baseline and after 3 cycles of chemotherapy for response assessment. Image analysis was performed by 2 observers, based on the RECIST criteria (version 1.1). RESULTS: Computed tomography revealed partial response of hepatic metastases in 7 patients (25%) by one observer and in 10 patients (35.7%) by the other observer, with good inter-observer agreement (k=0.75, percent agreement of 89.29%). Stable disease was detected in 19 patients (67.8%) by one observer and in 16 patients (57.1%) by the other observer, with good agreement (k=0.774, percent agreement of 89.29%). Progressive disease was detected in 2 patients (7.2%) by both observers, with perfect agreement (k=1, percent agreement of 100%). The overall inter-observer agreement in the CT-based response assessment of hepatic metastasis between the two observers was good (k=0.793, percent agreement of 89.29%). CONCLUSIONS: We concluded that computed tomography is a reliable and reproducible imaging modality for response assessment of hepatic metastases of breast cancer according to the RECIST criteria (version 1.1).

Association between normative and self-perceived orthodontic treatment need in a Lebanese population.

The aims of this study were to investigate the association between normative and perceived orthodontic treatment need in a Lebanese population and the effect of sociodemographic status on orthodontic treatment need. A prospective cross-sectional clinical study was designed using a sample of 150 subjects (81 males and 69 females) aged 11-18years seeking dental treatment at Beirut Arab University. Normative orthodontic treatment need was scored using the two components of the Index of Orthodontic Treatment Need (IOTN), the Dental Health Component (DHC) and the Aesthetic Component (AC). Perceived need for orthodontic treatment was evaluated by scoring the AC of the IOTN. A total of 31.3% of the sample were in great need of orthodontic treatment according to the DHC of the IOTN. On the other hand, only 9% of the sample perceived their need to be definite. A significant positive but weak correlation was found between the normative and perceived need for orthodontic treatment. There was also a significant association between age and normative treatment need.

Extended high dose letrozole regimen versus short low dose letrozole regimen as an adjuvant to gonadotropin releasing hormone antagonist protocol in poor responders undergoing IVF-ET.

OBJECTIVE: To compare the efficacy and cost-effectiveness of extended high dose letrozole regimen/HPuFSH-gonadotropin releasing hormone antagonist (GnRHant) protocol with short low dose letrozole regimen/HPuFSH-GnRHant protocol in poor responders undergoing IVF-ET. METHODS: In this randomized controlled trial, 136 women who responded poorly to GnRH agonist long protocol in their first IVF cycle were randomized into two equal groups using computer generated list and were treated in the second IVF cycle by either extended letrozole regimen (5 mg/day during the first 5 days of cycle and 2.5 mg/day during the subsequent 3 days) combined with HPuFSH-GnRHant protocol or short letrozole regimen (2.5 mg/day from cycle day 3-7) combined with HPuFSH-GnRHant protocol. RESULTS: There were no significant differences between both groups with regard to number of oocytes retrieved and clinical pregnancy rate (5.39 ± 2.08 vs. 5.20 ± 1.88 and 22.06% vs. 16.18%, respectively).The total gonadotropins dose and medications cost per cycle were significantly lower in extended letrozole group (44.87 ± 9.16 vs. 59.97 ± 14.91 ampoules and 616.52 ± 94.97 vs. 746.84 ± 149.21 US Dollars ($), respectively).The cost-effectiveness ratio was 2794 $ in extended letrozole group and 4616 $ in short letrozole group. CONCLUSION: Extended letrozole regimen/HPuFSH-GnRHant protocol was more cost-effective than short letrozole regimen/HPuFSH-GnRHant protocol in poor responders undergoing IVF-ET.