Formulating interprofessional anesthesiology and operating room clinical management pathway during COVID-19 pandemic using experiential learning theory in a university hospital in Saudi Arabia.

As the number of COVID-19 cases is rapidly increasing internationally, management, recommendations and guidelines of COVID-19 are rapidly evolving and changing. Formulating local clinical management policies among institutions adopting these recommendations is vital to staff as well as the patients' safety. Also, training multidisciplinary teams on these policies is an important, yet challenging, part of the process. The purpose of this paper is to present the process that has been followed to formulate COVID-19-specific response anesthesiology and operating room (OR) policies at King Abdulaziz University Hospital, by applying David A. Kolb's experiential learning theory during simulation-based training. This project had a total of six simulation-based sessions (four simulation scenarios and two clinical drills) designed to test the efficacy and efficiency of the then current practice in the hospital, facing the COVID-19 pandemic. Qualitative data analysis was completed using qualitative thematic data analysis. To apply experiential Kolb's theory, session's checklist (two raters per session), outcomes, and participants' feedback to develop and improve clinical management pathway in the department were used. The 12 reports and participants' feedback highlighted three main areas for improvement. These are Personal Protective Equipment implementation, team dynamics, and airway management. This process then guided in creating a new understanding of the multidisciplinary clinical management pathway, in addition to enhancing viability of the current practice and clinical management guidelines and protocols, which were already established and adapted at the hospital before the COVID-19 pandemic crisis. The alignment with Kolb's experiential theory helped formulate anesthesiology and OR effective clinical management pathway has been demonstrated. Applying experiential learning theory by a clinical institute using interprofessional, multidisciplinary simulations and clinical drills can guide the process of formulating clinical management pathways during pandemic outbreaks.

Facile synthesis of light harvesting semiconductor bismuth oxychloride nano photo-catalysts for efficient removal of hazardous organic pollutants.

In the present work, bismuth oxychloride nanoparticles-a light harvesting semiconductor photocatalyst-were synthesized by a facile hydrolysis route, with sodium bismuthate and hydroxylammonium chloride as the precursor materials. The as-synthesized semiconductor photocatalysts were characterized using X-ray diffraction analysis, Fourier transform infra-red spectroscopy, Raman spectroscopy, Field emission scanning electron microscopy, X-ray photoelectron spectroscopy and Photoluminescence spectroscopy techniques. The crystal structure, morphology, composition, and optical properties of these facile synthesized bismuth oxychloride nanoparticles (BiOCl NPs) were compared to those of traditional bismuth oxychloride. In addition, the photocatalytic performance of facile-synthesized BiOCl NPs and traditional BiOCl, as applied to the removal of hazardous organic dyes under visible light illumination, is thoroughly investigated. Our results reveal that facile-synthesized BiOCl NPs display strong UV-Vis light adsorption, improved charge carrier mobility and an inhibited rate of charge carrier recombination, when compared to traditional BiOCl. These enhancements result in an improved photocatalytic degradation rate of hazardous organic dyes under UV-Vis irradiance. For instance, the facile-synthesized BiOCl NPs attained 100% degradation of methylene blue and methyl orange dyes in approximately 30 mins under UV-Vis irradiation, against 55% degradation for traditional BiOCl under similar experimental conditions.

The Impact of Expasyl® Gingival Retraction Paste on the Bond Strength of Self-etch and Total-etch Systems.

OBJECTIVE: To evaluate the influence of Expasyl® gingival retraction paste on the shear bond strength of self-etch and total-etch adhesive systems. MATERIALS AND METHODS: Twenty-four specimens of extracted, caries-free, sound human molars were used in this study. The molars were then cut vertically into halves through the buccal and lingual cusps. Forty-eight specimens were divided into four groups (total-etch, total-etch with Expasyl application, self-etch, self-etch with Expasyl application) and the shear bond strength was tested. RESULTS: Expasyl significantly reduced the shear bond strength of the self-etch and total-etch adhesive systems. The self-etch system showed relatively lower performance compared with the total-etch adhesive system. The shear bond strength values of the total-etch adhesive without Expasyl showed the highest bond strength (21.48 ± 2.89), while the self-etching group adhesive treated with Expasyl showed the lowest shear bond strength value (14.89 ± 1.81). CONCLUSION: From the observations of this in vitro study, it can be concluded that the use of Expasyl® gingival retraction system can negatively affect bond strength of adhesives. The total-etch system showed better compatibility to the Expasyl gingival retraction system than the self-etch.

Prevalence and factors associated with the use of illicit substances among male university students in Kuwait.

OBJECTIVES: To estimate the prevalence of illicit use of substances and identify the factors associated with illicit drug use among male students in the state-run Kuwait University and private universities in Kuwait. SUBJECTS AND METHODS: The study was a cross-sectional survey with a sample of 1,587 male students from both private universities (n = 869) and the public (n = 718) Kuwait University in Kuwait. A self-administered questionnaire was used to collect data. Overall lifetime prevalence of substance use was computed with 95% confidence interval. Logistic regression was used to identify the factors influencing substance use, which was adjusted for potential confounders. RESULTS: The total lifetime prevalence of illicit drug use was 14.4% and the most frequently used illicit substance was marijuana (11%). The substance use in general varied significantly (p ≤ 0.001) between private (18%) and public (10%) universities. Multivariate logistic regression model revealed that drug use was positively associated with age, poor academic performance, high family income, being an only child, divorced parents, and graduation from a private high school. CONCLUSION: Drug use among male university students in Kuwait was high and requires attention and appropriate intervention. The factors identified with drug use in this study could be utilized to develop appropriate public health policies and preventive measures that may improve the health status of the student population.

Bilateral tension pneumothorax and pneumoperitonium during laser pediatric bronchoscopy--case report and literature review.

We describe a case of a fifteen month old girl with a previous history of partially repaired congenital heart disease, presented for diagnostic bronchscopic evaluation of mid-tracheal narrowing. Intraoperatively, the surgical team decided to perform a transbronchoscopic laser resection of a granulation tissue over the previously placed airway stent. After repeated airway manipulations, the patient developed intraoperative bilateral tension pneumothoracis as well as tension pneumoperitonium. These complications were recognized, diagnosed and promptly treated and patient made full recovery. This paper presents a case details, reviews the literature about these life threatening complications and suggests ways to prevent poor outcomes.

Long-term follow-up of anterior uveitis after cataract extraction and intraocular lens implantation.

PURPOSE: To assess whether cataract surgery and intraocular lens (IOL) implantation in patients with anterior uveitis interfere with the natural course of the ocular disease. SETTING: Tertiary care center at the University of Rome "La Sapienza", Rome, Italy. METHODS: Cataract extraction and IOL implantation were performed in 24 patients with uveitis-related cataract: 12 with Fuchs' heterochromic iridocyclitis (Group 1) and 12 with other types of anterior uveitis (Group 2). The mean follow-up in the 2 groups was 33.6 months and 24.8 months, respectively. The number and severity (inflammatory score) of uveitis relapses in all patients over the same period were recorded. RESULTS: After surgery, the mean number and severity of uveitis relapses decreased: Group 1, from 1.83 +/- 1.90 (SD) to 1.00 +/- 1.21 and from 1.08 +/- 0.90 to 0.92 +/- 0.67, respectively; Group 2, from 2.74 +/- 3.44 to 1.25 +/- 1.71 and from 1.83 +/- 1.10 to 1.25 +/- 0.75, respectively (P = .046). There were no statistically significant between-group differences. In Group 2, a trend toward worse visual rehabilitation was seen; this was significantly different from the result in Group 1 (P = .018) because of preoperative optic nerve damage, macula disease, or both. CONCLUSION: Cataract surgery and IOL implantation did not negatively influence the natural course of uveitis in patients with Fuchs' heterochromic iridocyclitis. Correct surgical timing, selection of cases, and adequate anti-inflammatory therapy may promote similar results in patients with other types of anterior uveitis.

Endogenous uveitis: an analysis of 1,417 cases.

A retrospective study on 1,417 uveitic patients referred to the Ocular Immunovirology Service of the University of Rome 'La Sapienza' was carried out to determine the occurrence of the various forms of uveitis. To detect also the possible changing patterns of uveitis during the last 25 years the obtained data were compared with those reported in two previous studies performed by the same author, at the same institution in 1978 and 1985. Anterior uveitis was the most frequent anatomical type of intraocular inflammation (49.12%); intermediate uveitis was diagnosed in 12.42% of all the cases and showed an increased incidence over the years (p < 0.0001). Posterior and diffuse uveitis accounted for 22.1 and 16.37% of the cases. An improvement in diagnostic definition has been confirmed by the significant decrease in the percentage of 'idiopathic uveitis' from 56.8 to 38.1% (p < 0.0001). Associated infectious conditions were detected in 17.43% of the cases. Toxoplasma gondii was the most common etiologic agent of uveitis (6.63%). An associated systemic disease was diagnosed in 15.03% of uveitic patients, and 6% of them were affected with Behçet's disease. Specific ocular diseases and clinical entities increased from 7.8 and 14.68% to 29.42% in the last 25 years (p < 0.0001), the most frequent being pars planitis (11.99%) and Fuchs' heterochromic iridocyclitis (8.32%).

Behçets disease in children.

Ophthalmic and clinical analysis were carried out on 16 children and 122 adult patients affected by Behçet's disease (BD) to delineate the clinical features of BD in childhood and to investigate the differences between the expression of the disease in children and adults. The mean follow-up period was 7.8 and 7 years, respectively. Pediatric onset of BD was found in 7.6% of all the cases with a male:female ratio of 1.29:1. The complete type of the disease was observed in 50% of the children. No statistical significant differences were noted between children and adults in the incidence of oral aphthae, genital ulcers, skin lesions, arthritis, gastrointestinal involvement, neuropsychiatric symptoms and the presence of HLA-B51. Thrombophlebitis was associated with the onset of the disease in adult age (P=0.022). Uveitis alone or in combination with other major symptoms was the presenting sign in a higher percentage of children (P=0.077), As in adults, in children diffuse uveitis was the most common type of ocular inflammation, while ocular complications have been found mainly in children (P=0.021), who more frequently developed cataract, maculopathy and retinal detachment (P=0.024). Both adult and young male patients have shown a lower age at onset and higher rate of optic atrophy than females. In conclusion, no significant differences have been found between children and adults in the expression of the major and most of the minor symptoms of BD. Ocular involvement in childhood may be very severe, as was confirmed by the high frequency of diffuse uveitis and ocular complications. Young males, as adult males, showed an earlier onset of the disease and a worse ocular prognosis.