Perception of Healthcare Providers during the COVID-19 Pandemic: A Mixed Method Survey in an Integrated Healthcare Delivery System in Saudi Arabia.

During the COVID-19 pandemic, telemedicine was broadly adopted for patient care. Considering this experience, it is crucial to understand the perceptions of teleclinic healthcare professionals. In Saudi Arabia, telemedicine literature was restricted to physicians working in government and private hospitals. This study examined perceptions in relation to telemedicine among physicians and other healthcare professionals practicing in Saudi Arabian military hospitals in the Taif region. During COVID-19, telemedicine was implemented in military hospitals; consequently, this study assists in evaluating introduced practices and the perceptions of health professionals regarding these new practices. A quantitative, descriptive, correlational, and cross-sectional study was undertaken on healthcare professionals (N = 153). Twenty (20) items based on standardized measures were used to collect data using an online questionnaire. The measures contained three subscales: perceived usefulness, perceived ease, and behavioral intention. It was hypothesized that the perception of teleclinic usefulness and ease score by healthcare providers would be significantly correlated with behavioral intention. Descriptive statistics for mean, frequency, and standard deviation, as well as a Pearson correlation coefficient and regression analysis, were conducted to assess the relationship and predictive association between variables. In addition, a focus group discussion was organized to collect information directly from healthcare professionals. Most of the participants were approximately 40 years of age, Saudi Nationals (63%), medical specialists (62%), and were involved in teleclinic practices before the COVID-19 pandemic (60%). The reliability of all three scales was determined to be acceptable (α = 0.75-0.91). Perceived usefulness and perceived ease were shown to be significantly correlated with behavioral intention (r = 0.877, p = 0.05). In addition, the regression analysis indicated that perceived usefulness and perceived ease are predictors of the behavioral intention (R2 = 0.777, F (2,152) = 261.76, p = 0.001) of teleclinic practices among healthcare professionals. The positive perception of telemedicine integration in healthcare systems revealed by this study is a major catalyst for continuous adoption. On the other hand, certified telemedicine platforms, on-the-job training, Internet of things, and a flexible approach are required to find opportunities and enhancements in telemedicine interactions.

The effect of alpha lipoic acid supplementation on sperm functions in idiopathic asthenozoospermic patients: a case-controlled study.

Alpha-lipoic acid (ALA) is a natural short chain fatty acid containing sulfhydryl groups generated from octanoic acid and cysteine in the mitochondria, and is found in both the aqueous and lipid phases. The present study aimed to assess the efficacy of ALA supplementation in primary infertile males complaining of idiopathic asthenozoospermia. Eighty patients were randomly allocated to treatment group A (n = 40) and control group B (n = 40) groups, receiving daily doses of 600 mg (divided into two daily doses of 300 mg each) of alpha lipoic acid (ALA) or an identical placebo for 90 days. Semen analysis, anthropometric and total antioxidant capacity were analysed and compared before and after treatment. Daily supplementation with ALA improved total motility and progressive motility of the spermatozoa. In the ALA-treated group, sperm motility and progressive motility increased significantly, similarly, the mean percentage of sperm vitality demonstrated a significant increase among the ALA treated group (p < 0.001). Analysis revealed a statistically significant increase in semen volume and sperm concentration in the ALA supplemented group, while abnormal morphology decreased significantly (p < 0.001). ALA supplementation significantly improved sperm parameters and functional tests in group A patients. ALA supplementation in patients with idiopathic asthenozoospermic thus enhanced sperm quality and viability, which could therefore be considered as an adjunct therapy pending further verification of its association and mechanisms involved.

Diagnostic and therapeutic implications of vitamin D deficiency in patients with warts: A case-controlled study.

BACKGROUND: Cutaneous warts are frequent conditions that possess much challenge to treat. OBJECTIVE: To verify the potential role of vitamin D in the pathogenesis of viral warts by measuring the serum levels of vitamin D in patients diagnosed with viral warts compared to healthy controls and to verify whether oral vitamin D supplementation of those vitamin D-deficient patients would result in wart clearance. METHODS: To evaluate the serum vitamin D levels, the study recruited 80 subjects, including 40 patients diagnosed with viral warts and 40 age- and sex-matched healthy controls. All patients were subjected to detailed history taking and examination to detect duration and type of warts. Serum vitamin D levels were measured using ELISA. RESULTS: Thirty-five percent of patients had sufficient vitamin D levels (54-90 nmol/L), and 40% of patients had insufficient levels (50-80 nmol/L), while 25% of them had deficient levels (<50 nmol/L). In healthy group, 30% had sufficient levels, and 45% had insufficient levels, while 25% had deficient levels. There was an insignificantly lower serum level of vitamin D as well as an insignificantly deficient vitamin D status among patients compared to healthy controls. CONCLUSION: Vitamin D serum levels appear to be lower among viral wart patients, and oral supplementation studies need to be more intensely investigated before elucidating its role; if any, in wart clearance.

Pumpkin seed oil vs. minoxidil 5% topical foam for the treatment of female pattern hair loss: A randomized comparative trial.

BACKGROUND: Pumpkin (Cucurbita pepo L.) is an annual climber plant, and its seeds have considerable amount of oil with nutritional and medicinal importance. AIM: The present study aimed to investigate the clinical efficacy of pumpkin seed oil (PSO) in the treatment of female pattern hair loss (FPHL) and compare its effects with minoxidil 5% foam. METHODS: Patients with FPHL were randomly assigned to pumpkin seed oil (n = 30; group A) or minoxidil 5% foam (n = 30; group B) for a period of 3 months. Patients were evaluated clinically and dermoscopically at baseline, at one and half months, and at the end of the 3-month study. RESULTS: Among group A (pumpkin seed oil) candidates, a significant decrease was observed in hair shaft diversity before and after treatment (30.5 ± 6.2%, 24.0 ± 4.02, P < .001, respectively) as well as in the vellus hairs (22.5 ± 4.9, 15.8 ± 2.2, P < .001, respectively). Upright regrowing hairs significantly increased from (0.13 ± 0.5) before treatment to (0.9 ± 1.0) after treatment (P < .001). In group B (minoxidil applying) candidates, a significant decrease was observed in hair shaft diversity before and after treatment (31.5 ± 6.3%, 21.3 ± 2.2, P < .001, respectively) as well as in the vellus hairs (24.7 ± 6.4, 19.5 ± 5.4, P = .02, respectively). Conclusion Findings of the present trial provide evidence of a promising potential role of PSO in treating FPHL.

Auxiliary Partial Orthotopic Liver Transplantation for Monogenic Metabolic Liver Diseases: Single-Centre Experience.

PURPOSE: Auxiliary partial orthotopic liver transplantation (APOLT) in metabolic liver disease (MLD) has the advantage of correcting the metabolic defect, preserving the native liver for gene therapy in the future with the possibility of withdrawal of immunosuppression. METHODS: Retrospective analysis of safety and efficacy of APOLT in correcting the underlying defect and its impact on neurological status of children with MLD. RESULTS: A total of 13 APOLT procedures were performed for MLD during the study period. The underlying aetiologies being propionic acidemia (PA)-5, citrullinemia type 1 (CIT1)-3 and Crigler-Najjar syndrome type 1 (CN1)-5 cases respectively. Children with PA and CIT1 had a median of 8 and 4 episodes of decompensation per year, respectively, before APOLT and had a mean social developmental quotient (DQ) of 49 (<3 standard deviations) as assessed by Vineland Social Maturity Scale prior to liver transplantation. No metabolic decompensation occurred in patients with PA and CIT1 intraoperatively or in the immediate post-transplant period on protein-unrestricted diet. Patients with CN1 were receiving an average 8-15 h of phototherapy per day before APOLT and had normal bilirubin levels without phototherapy on follow-up. We have 100% graft and patient survival at a median follow-up of 32 months. Progressive improvement in neurodevelopment was seen in children within 6 months of therapy with a median social DQ of 90. CONCLUSIONS: APOLT is a safe procedure, which provides good metabolic control and improves the neurodevelopment in children with selected MLD.

Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study.

PURPOSE: The extracorporeal shockwave lithotripsy (ESWL) remains the most common first line of treatment for renal stones in the pediatric population. The purpose of this study is to evaluate and compare the outcomes of the ESWL and mini-percutaneous nephrolithotomy (mini-PCNL). PATIENTS AND METHODS: A total of 108 patients younger than 12 years of age with 1-2 cm single renal stone (pelvic or calyceal) were randomized into two groups, each containing 54 patients. Patients in group A were subjected to mini-PCNL using 16.5 Fr percutaneous sheath while those in group B underwent ESWL using Dornier Compact Sigma. RESULTS: The stone-free rate (SFR) after first session was 88.9% (48 cases) and 55.6% (30 cases) for groups A and B, respectively. The difference is highly statistically significant P = 0.006. Two patients (3.7%) in group A needed 2nd session of PCNL, while 18 patients (33.3%)in group B needed a 2nd session, of theses 18 patients six patients needed a 3rd session of ESWL. After the third session of ESWL and second look PCNL the stone-free rates were 92.59% (50 cases) and 88.89% (48 cases) for groups A and B, respectively, (P = 0.639), which is statistically insignificant. The mean hospital stay and fluoroscopy exposure were significantly longer in the mini-PCNL group. The complication rate in groups A and group B were (22.2%) and (14.8%), respectively, which is statistically insignificant (P = 0.484). CONCLUSIONS: According to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.

Oleanolic acid: a novel cardioprotective agent that blunts hyperglycemia-induced contractile dysfunction.

Diabetes constitutes a major health challenge. Since cardiovascular complications are common in diabetic patients this will further increase the overall burden of disease. Furthermore, stress-induced hyperglycemia in non-diabetic patients with acute myocardial infarction is associated with higher in-hospital mortality. Previous studies implicate oxidative stress, excessive flux through the hexosamine biosynthetic pathway (HBP) and a dysfunctional ubiquitin-proteasome system (UPS) as potential mediators of this process. Since oleanolic acid (OA; a clove extract) possesses antioxidant properties, we hypothesized that it attenuates acute and chronic hyperglycemia-mediated pathophysiologic molecular events (oxidative stress, apoptosis, HBP, UPS) and thereby improves contractile function in response to ischemia-reperfusion. We employed several experimental systems: 1) H9c2 cardiac myoblasts were exposed to 33 mM glucose for 48 hr vs. controls (5 mM glucose); and subsequently treated with two OA doses (20 and 50 µM) for 6 and 24 hr, respectively; 2) Isolated rat hearts were perfused ex vivo with Krebs-Henseleit buffer containing 33 mM glucose vs. controls (11 mM glucose) for 60 min, followed by 20 min global ischemia and 60 min reperfusion ± OA treatment; 3) In vivo coronary ligations were performed on streptozotocin treated rats ± OA administration during reperfusion; and 4) Effects of long-term OA treatment (2 weeks) on heart function was assessed in streptozotocin-treated rats. Our data demonstrate that OA treatment blunted high glucose-induced oxidative stress and apoptosis in heart cells. OA therapy also resulted in cardioprotection, i.e. for ex vivo and in vivo rat hearts exposed to ischemia-reperfusion under hyperglycemic conditions. In parallel, we found decreased oxidative stress, apoptosis, HBP flux and proteasomal activity following ischemia-reperfusion. Long-term OA treatment also improved heart function in streptozotocin-diabetic rats. These findings are promising since it may eventually result in novel therapeutic interventions to treat acute hyperglycemia (in non-diabetic patients) and diabetic patients with associated cardiovascular complications.

Potential adverse reactions to herbal medicines in patients attending a nephrology clinic in Abu Dhabi, United Arab Emirates.

OBJECTIVE: To provide data on herbal medicine (HM) use and safety in patients attending a nephrology clinic at Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates (UAE). METHODS: A prospective, 3-month study between June and September 2007, investigated all patients presenting to the Nephrology Clinic of the Sheikh Khalifa Medical center (SKMC) in Abu Dhabi, UAE. A structured questionnaire determined previous and current HM use, and descriptions of associated adverse reactions. Corroborating evidence was sought from the patient's medical records. Causality was assessed by consensus from an expert panel using the Naranjo algorithm. RESULTS: The HM use was widespread (468 of 688; 68%). Over two-thirds (69%) reported currently taking 3 or more herbal preparations. Patients reported using over 100 different HMs, many of them compounded mixtures; 35% could not identify a single ingredient of these mixtures, and 70% had not informed the clinic doctors that they were taking HMs. Just 2 patients had HM use recorded in their medical record. Twenty-eight HM-related adverse reactions were identified in 26 (5.6%) patients; 12 probably and 16 possibly related to HMs. Seven involved HMs alone and 21, a HM/prescription medication (PM) interaction. CONCLUSION: The use of HMs in patients with underlying kidney problems was extensive and contributed additional pathology to the underlying renal disease, either alone or in combination with PMs. The reluctance of patients to inform their healthcare providers of concurrent use highlights a need to take a thorough drug history on clinic registration.

Baicalein inhibits formation of α-synuclein oligomers within living cells and prevents Aß peptide fibrillation and oligomerisation.

Abnormal protein aggregation in the brain is linked to the pathogenesis of neurodegenerative diseases, including Alzheimer's disease (AD) and Parkinson's disease (PD). Recent studies revealed that the oligomeric form of aggregates is most likely the toxic species, and thus could be a good therapeutic target. To screen for potent inhibitors that can inhibit both oligomerisation and fibrillation of α-synuclein (α-syn), we systematically compared the antioligomeric and antifibrillar activities of eight compounds that were extracted from Chinese herbal medicines through three platforms that can monitor the formation of α-syn fibrils and oligomers in cell-free or cellular systems. Our results revealed that baicalein, a flavonoid extracted from the Chinese herbal medicine Scutellaria baicalensis Georgi ("huang qin" in Chinese), is a potent inhibitor of α-syn oligomerisation both in cell-free and cellular systems, and is also an effective inhibitor of α-syn fibrillation in cell-free systems. We further tested the protective effect of baicalein against α-syn-oligomer-induced toxicity in neuronal cells. Our data showed that baicalein inhibited the formation of α-syn oligomers in SH-SY5Y and Hela cells, and protected SH-SY5Y cells from α-syn-oligomer-induced toxicity. We also explored the effect of baicalein on amyloid-ß peptide (Aß) aggregation and toxicity. We found that baicalein can also inhibit Aß fibrillation and oligomerisation, disaggregate pre-formed Aß amyloid fibrils and prevent Aß fibril-induced toxicity in PC12 cells. Our study indicates that baicalein is a good inhibitor of amyloid protein aggregation and toxicity. Given the role of these processes in neurodegenerative diseases such as AD and PD, our results suggest that baicalein has potential as a therapeutic agent for the treatment of these devastating disorders.

Increased calcium influx through acetylcholine receptors in dunce neurons.

Calcium homeostasis was studied in dunce, a Drosophila mutant that is defective in learning and memory. Fura 2-AM fluorescence photometry was used to measure the intracellular calcium concentration in wild type and dunce cleavage-arrested neurons under resting conditions and in response to neurotransmitters. After acetylcholine application, the peak [Ca2+]i was greater in dunce (693 +/- 125 nM) than in wild type neurons (464 +/- 154 nM), but half decay time was shorter in dunce (66 +/- 15 s) than in wild type neurons (104 +/- 40 s). In contrast, the application of glutamate, NMDA, dopamine, and serotonin had no effect on [Ca2+]i. These results indicate that calcium influx through acetylcholine receptors is increased in dunce, compared to wild type neurons. The results also suggest that calcium extrusion to the outside and/or calcium buffering are enhanced in dunce, compared to wild type neurons. This disturbance in the homeostasis of cytosolic calcium concentration in dunce may be implicated in defective associative learning in Drosophila, and may play a role in acute and chronic neurodegenerative disorders in the mammalian brain.