Patients' Experiences of Remote Neurology Consultations during the COVID-19 Pandemic.

Telemedicine has been widely implemented during the COVID-19 global pandemic to enable continuity of care of chronic illnesses. We modified our general neurology clinic to be conducted using remote audio-only telephone consultations. We included all patients over a 10-week period who agreed to both a telephone consultation and a questionnaire afterwards in order to ascertain the patient's perspective of the experience. There were 212 participants consisting of men (43.8%) and women (56.2%). The mean ± standard deviation of age was 47.8 ± 17.0 (range 17-93) years. For the most part, patients found remote consultations either "just as good" (67.1%) or "better" (9.0%) than face-to-face consultations. Those who deemed it to be "not as good" were significantly older (52.3 ± 17.9 years vs. 46.6 ± 16.6 years, p =0.045) or were more likely to have a neurological disorder that required clinical examination, namely, a neuromuscular condition (66.7%, p = 0.002) or an undiagnosed condition (46.7%, p = 0.031). At the height of the COVID-19 global pandemic, most patients were satisfied with remote consultations. The positive feedback for remote consultations needs to be verified outside of this unique scenario because the results were likely influenced by the patients' apprehension to attend the hospital amongst other factors.

Isolation of Aerobic Heterotrophic Bacteria from a Microbial Mat with the Ability to Grow on and Remove Hexavalent Chromium through Biosorption and Bioreduction.

Water pollution with toxic hexavalent chromium, Cr(VI), is an environmental threat that has a direct impact on living organisms. The use of microorganisms from microbial mats to remove Cr(VI) has scarcely been investigated. Here, we isolated aerobic heterotrophic bacteria from a Cr-polluted microbial mat found in a mining site in Oman, and investigated their ability to remove Cr(VI), and the underlying mechanism(s) of removal. All isolates fell phylogenetically into the genera Enterobacter, Bacillus, and Cupriavidus, and could completely remove 1 mg L-1 Cr(VI) in 6 days. The strains could tolerate up to 2000 mg L-1 Cr(VI), and exhibited the highest Cr(VI) removal rate at 100 ± 9 mg L-1 d-1. Using scanning electron microscopy (SEM) coupled with elemental analysis, the strains were shown to adsorb Cr(VI) at their cell surfaces. The functional groups OH, NH2, Alkyl, Metal-O, and Cr(VI)-O were involved in the biosorption process. In addition, the strains were shown to reduce Cr(VI) to Cr(III) with the involvement of chromate reductase enzyme. We conclude that the aerobic heterotrophic bacteria isolated from Cr-polluted microbial mats use biosorption and bioreduction processes to remove Cr(VI) from wastewater.

Mood symptoms in cervical dystonia: Relationship with motor symptoms and quality of life.

Background: Cervical dystonia (CD) has a high prevalence of anxiety and depression. The relationship between motor severity, mood symptoms and QoL is unclear and how to adequately assess these is also unknown. Instruments like the BAI, BDI and HADS are often used but items within these relating to somatic symptoms might influence the results. Methods: Patients with idiopathic cervical dystonia (CD) were included. The BAI, BDI, HADS, CIDP58 and TWSTRS2- severity score were used for assessment of motor, mood and QoL symptoms. Pearson's correlations between motor and non-motor symptom scores were assessed. The psychometric properties of the psychiatric tools were measured and principal component analysis performed after identifying items that could correspond to somatic symptoms. Results: 201 participants were included. 42% of participants had either significant depression or anxiety symptoms or both when measured by BAI and BDI and 51% of patients met criteria on HADS. HADS-A and HADS-D, BAI and BDI were poorly correlated with TWSTRS2-S. The HADS-A and HADS-D both showed strong correlation with the sleep subdomain of CDIP58. Psychometric and principal component analysis on 149/201 participants did not reveal factor loadings consistent with the a priori somatic groupings. However mean scores were higher for somatic items. Conclusion: A good score on the CDIP58, a commonly used tool, does not indicate mild disease severity or minimal mood symptoms. Minimal motor symptoms, similarly, also does not imply a positive QoL. Clinicians should be mindful on ideal methods for performing a holistic assessment of CD patients. This likely warrants a combination of motor, QoL and mood assessment tools.

Degradation of starch-based bioplastic bags in the pelagic and benthic zones of the Gulf of Oman.

The Gulf of Oman is becoming increasingly polluted with plastics, hence bioplastics have been considered 'a substitute', although their biodegradability in marine environments has not been well investigated. Most research has been performed on cellulose-based bioplastics, whereas starch-based bioplastics have proven to be a suitable, but less researched, alternative. This study is the first of its kind designed to investigate the degradability of two different types of starch-based bioplastic bags, available in the market and labeled as "biodegradable", in the pelagic and benthic zones of one of the warmest marine environment in the world. Fourier-Transform Infrared Spectroscopy (FTIR) showed a clear reduction in the presence of OH, CH, and CO in the bioplastic bags after 5 weeks of immersion. Thermo-Gravimetric Analysis (TGA) indicated degradation of glycerol, starch, and polyethylene. The biofouling bacterial communities on bioplastic surfaces showed distinct grouping based on the immersion zone. Candidaatus saccharibacteria, Verrucomicrobiae, Acidimicrobiia and Planctomycetia sequences were only detectable on bioplastics in the pelagic zone, whereas Actinomyces, Pseudomonas, Sphingobium and Acinetobacter related sequences were only found on bioplastics in the benthic layer. We conclude that starch-based bioplastics are more readily degradable in the Gulf of Oman than conventional plastics, hence could serve as a better environmentally friendly alternative.

Effect of partially hydrolyzed polyacrylamide (HPAM) on the bacterial communities of wetland rhizosphere soils and their efficiency in HPAM and alkane degradation.

The effect of partially hydrolyzed polyacrylamide (HPAM) on structure and function of rhizosphere soil bacterial communities in constructed wetlands has been largely underinvestigated. In this study, we compare the effect of 250, 500, and 1000 mg/L of HPAM on bacterial community composition of Phragmites australis associated rhizosphere soils in an experimental wetland using MiSeq amplicon sequencing. Rhizosphere soils from the HPAM-free and the 500-mg/L-exposed treatments were used for laboratory experiments to further investigate the effect of HPAM on the soil's degradation and respiration activities. Soils treated with HPAM showed differences in bacterial communities with the dominance of Proteobacteria and the enrichment of potential hydrocarbon and HPAM-degrading bacteria. CO2 generation was higher in the HPAM-free soils than in the HPAM pre-exposed soil, with a noticeable increase in both soils when oil was added. The addition of HPAM at different concentrations had a more pronounced effect on CO2 evolution in the HPAM-pre-exposed soil. Soils were able to degrade between 37 ± 18.0 and 66 ± 6.7% of C10 to C30 alkanes after 28 days, except in the case of HPAM-pre-exposed soil treated with 500 mg/L where degradation reached 92 ± 4.3%. Both soils reduced HPAM concentration by 60 ± 15% of the initial amount in the 500 mg/L treatment, but by only ≤ 21 ± 7% in the 250-mg/L and 1000-mg/L treatments. In conclusion, the rhizosphere soils demonstrated the ability to adapt and retain their ability to degrade hydrocarbon in the presence of HPAM.

Good Clinical Success Rates Are Seen 5 Years After Meniscal Repair in Patients Regularly Undertaking Extreme Flexion.

PURPOSE: To report the functional and radiologic outcomes of meniscal repair healing in a cohort of patients with a high demand for loaded extreme flexion angles after undergoing meniscal repair. METHODS: We performed a retrospective clinical and radiologic evaluation of patients who perform extreme knee flexion activities on a daily basis at a minimum follow-up of 2 years after meniscal repair. International Knee Documentation Committee, Lysholm, and Tegner scores were obtained, and clinical examinations and radiologic (magnetic resonance imaging and radiography) evaluations were performed. RESULTS: Of 47 eligible patients, 39 patients (40 knees) were available for review with an average follow-up time of 5 years (range, 2-9 years). The average age was 26.7 years (range, 19-39 years); 38 patients were men. The average time from injury to surgery was 20.9 months (range, 3 days to 120 months). Associated anterior cruciate ligament injury was present in 31 knees, but only 20 underwent simultaneous anterior cruciate ligament surgery. The mean International Knee Documentation Committee score was 88.9 (range, 53-99). The mean Lysholm score was 90.9 (range, 48-100). The mean Tegner activity level dropped from 6.18 before injury to 5.51 at the time of evaluation. According to the Barrett criteria for clinical outcomes, complete healing was observed in 29 of 40 knees (72.5%). There was a statistically significant correlation between the functional outcomes and the clinical outcomes (P = .008). On magnetic resonance imaging, 22 of 38 knees (57.9%) showed completely healed menisci. CONCLUSIONS: The results of this study suggest that loaded deep knee flexion may be safe after a period of restricted rehabilitation, and clinical and radiologic tissue healing is independent of the overall functional outcome. LEVEL OF EVIDENCE: Level IV, case series with subgroup analysis.

Vaccine hesitancy among people with multiple sclerosis.

BACKGROUND: The current severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has raised awareness of vaccine hesitancy. Specific reasons for vaccine hesitancy among people with multiple sclerosis (pwMS) have not been fully described. Notably, pwMS may experience higher morbidity from vaccine-preventable diseases such as influenza, pneumococcal disease, and human papillomavirus (HPV)-associated warts and malignancies. Furthermore, screening for immunity against measles, mumps and rubella (MMR) is not standard practice, despite a resurgence of measles and mumps outbreaks in Europe and worldwide. We aimed to evaluate general vaccination status among pwMS to better inform vaccine practices in this cohort. METHODS: This was a prospective audit of pwMS attending an Irish tertiary referral MS centre. We designed a questionnaire that explored awareness, uptake, and hesitancy for the influenza, pneumococcal, SARS-CoV-2, HPV, and MMR vaccines. The clinician administered the questionnaire during the outpatient MS clinic. RESULTS: One-hundred-and-five pwMS participated in the audit, mean (SD) age 47.3 (12.8) years, mean MS disease duration 14.1 (9.5) years, median Expanded Disability Severity Scale (EDSS) score 2.0 (IQR 1.0-6.0), forty-nine (46.7%) were taking either maintenance immunosuppressive or immune reconstitution therapies. SARS-CoV-2 vaccine willingness among pwMS was higher (90.5 vs 60-80%) than that reported in other Western countries, and higher than that for the influenza and pneumococcal vaccines (∼80%) for which perceived unnecessity and unfamiliarity respectively were the main limiting factors. The primary reason for SARS-CoV-2 vaccine hesitancy was safety concern. PwMS who were explicitly advised by a healthcare professional to obtain the influenza vaccine were more likely to do so than those who were not (odds ratio, 8.1, 95% CI 2.8 - 23.4, p<0.001). Of pwMS currently receiving B-cell therapy (ocrelizumab/rituximab, n=12), all but one (n=11, 91.7%) have never received the pneumococcal vaccine, and a quarter (n=3) were uncertain whether to obtain this in the future. Patient-reported uptake of HPV (1.0%) and MMR (51.4%) vaccines were suboptimal. Prevalence of vaccine promotion among healthcare professionals was low (influenza vaccine, 4.8 - 32.4%; pneumococcal vaccine, 0 - 18.1%). CONCLUSIONS: Vaccine hesitancy is common (10-20%) in pwMS, consequent to insufficient knowledge and misconceptions about vaccination among pwMS and suboptimal vaccine promotion by healthcare professionals who manage pwMS. Conscientious and context-specific vaccination counselling is necessary to tackle vaccine hesitancy among pwMS, including (i) avoiding infection-associated disability accrual during MS relapses, (ii) reducing the potentially higher risk of life-threatening/treatment-refractory complications that may be observed in those who develop vaccine-preventable infections while receiving certain DMTs, and (iii) avoiding attenuated vaccine responses or delayed/interrupted DMT with early pre-treatment vaccine delivery where possible.