Comparison of HVT-ND recombinant and convection-based Newcastle disease vaccination programs in the protection against the genotype VII NDV challenges: an experimental study.

Newcastle disease virus (NDV) belongs to the Avulavirus genus and Paramyxoviridae family virus that causes acute, highly infectious Newcastle disease in poultry. The two proteins of haemagglutinin neuraminidase (HN) and fusion (F) are key virulence factors with an important role in its immunogenicity. Genotype VII NDV is still among the most serious viral hazards to the poultry industry worldwide. In this study, a commercial vector vaccine (HVT-NDV) was evaluated compared to the conventional vaccination strategy against Iranian genotype VII. This experiment showed that the group receiving the conventional vaccination strategy had higher antibodies, fewer clinical signs, and lower viral loads in tracheal swabs and feces. Also, two vaccine groups showed significant difference, which could have resulted from two extra vaccine doses in the conventional group. However, except for antibody levels in commercial chickens in the Iran new-generation vaccine, this difference was minor. Further, both groups showed 100% protection in the challenge study. Despite the phylogenetic gap between the NDV-F gene placed in the vector vaccine and the challenge virus (genotypes I and VII, respectively), the rHVT-NDV vaccine offered strong clinical protection and decreased challenge virus shedding considerably.

Lived experiences of Palestinian patients with COVID-19: a multi-center descriptive phenomenological study of recovery journey.

BACKGROUND: Exploring lived experiences of recovered COVID-19 patients might have scientific, social, and policy relevance that can apply to the healthcare infrastructure. This multi-center descriptive phenomenological study was conducted to explore lived experiences of Palestinian patients who recovered from COVID-19. METHODS: This was a descriptive phenomenological study. A purposive sampling technique was used to recruit the study participants. Semi-structured qualitative interviews were conducted with patients who recovered from COVID-19 (n = 20). The interviews were transcribed verbatim. The transcripts were analyzed using Colaizzi's phenomenological approach which consisted of the following steps: 1) familiarization, 2) identification of significant statements, 3) formulation of the meanings, 4) clustering the themes, 5) development of an exhaustive description of the phenomenon, 6) production of the fundamental structure, and 7) verification of the fundamental structure. RESULTS: Semi-structured interviews were conducted with 14 male and 6 female patients who recovered from COVID-19. The total duration of the interview time was 998 min (16.6 h). The qualitative data collected during the interviews were categorized into 5 major themes and 16 subthemes that exhaustively described the phenomenon. The major themes were relevant to: 1) emotions after learning about the infection, 2) experiencing social exclusion and stigma, 3) the experienced symptoms, 4) supportive treatments, herbs, rituals, and social support, 5) and life after recovery. CONCLUSION: The interviewees recounted experiencing negative emotions, social exclusion, and stigma because of their infection. It may be important for mental health promotion to be an integral part of the care plan for patients with COVID-19. More studies are still needed to investigate if introducing mental healthcare providers to the care team of patients with COVID-19 can improve the experiences of the patients.

Effects of dietary ß-glucan on the growth and innate immune response of juvenile Persian sturgeon, Acipenser persicus.

The present study evaluated the effects of different levels of dietary ß-glucan (MacroGard(®)) on growth performance and innate immune parameters in juvenile Persian sturgeon (Acipenser persicus). Fish (20.1 ± 0.8 g) were allocated into 12 tanks (15 fish per tank) and triplicate groups were fed a control diet or diets containing 0.1%, 0.2% and 0.3% ß-glucan. After six weeks of daily feeding (3.0% body weight day(-1)), humoral innate immune parameters (serum immunoglobulin (Ig) levels, lysozyme activity and alternative complement activity (ACH50)) and growth parameters (final weight, weight gain, specific growth rate (SGR), food conversion ratio (FCR)) were examined. Innate immune responses (lysozyme activity and ACH50) were significantly higher in 0.2% and 0.3% ß-glucan fed fish (P < 0.05). Similarly, elevated growth performance (final weight, SGR and FCR) was observed in fish fed 1%, 2% and 3% ß-glucan compared to the control group (P < 0.05). However, dietary ß-glucan had no significant effect on survival rate of fish (P > 0.05). These results indicate that ß-glucan can be considered as a beneficial dietary supplement for improving the immune response and growth performance of Persian sturgeon.

Effect of freezing rate on motility, adenosine triphosphate content and fertilizability in beluga sturgeon (Huso huso) spermatozoa.

Broodstock selection programs are currently underway for sturgeon species. To complement and further these selection programs we need to develop sperm cryopreservation procedures. In the present study, we describe the effects of freezing rate (-10°C, -15°C, -20°C, -30°C and -40°C/min) on gamete quality characteristics (i.e., duration of motility (s), motility percentage (%), ATP content (nmol/10(8) cells), fertilization rate (%), and hatching rate (%)) in beluga sturgeon, Huso huso. After sampling, beluga sturgeon sperm were diluted in an extender composed of 23.4mM sucrose, 0.25 mM KCl, and 30 mM Tris-HCl, pH 8.0 containing 10% methanol and subsequently frozen in a programmable freezer. Sperm frozen at -40°C/min resulted in means for duration of motility (134 s), motility percentage (69%), ATP concentration (4.8 nmol/10(8) cells), fertilization rate (72%) and hatching rate (65%) that were higher (P<0.05) than those for slower cooling rates. Based on our results, -40°C/min was the best freezing rate (among those tested) for cryopreservation of beluga sturgeon sperm.

Motility and fertility of cryopreserved semen in Persian sturgeon, Acipenser persicus, stored for 30-60 min after thawing.

We investigated the effect of storage times of frozen-thawed Persian sturgeon (Acipenser persicus) semen on the duration of sperm motility, percentage of motile sperm, and fertilization and hatching rates of fresh sperm and sperm stored for 0, 30, and 60 min at 4°C post-thawing. Frozen thawed semen analyzed immediately after thawing had similar quality characteristics as fresh semen. For cryopreserved semen stored for 30 min after thawing the characteristics did not differ to fresh semen and cryopreserved semen. For cryopreserved semen stored for 60 min a significant decline in the parameters was observed. Fertilization and hatching rates were not affected by storage times of maximally 30 min of storage.

The three integrated phases of left atrial macrophysiology and their interactions.

Our understanding of the left atrium is growing, although there are many aspects that are still poorly understood. The left atrium size as an imaging biomarker has been consistently shown to be a powerful predictor of outcomes and of different cardiovascular disorders, such as, but not limited to, atrial fibrillation, congestive heart failure, mitral regurgitation and stroke. Left atrial function has been conventionally divided into three integrated phases: reservoir, conduit and booster-pump. The highly dynamic left atrium and its response to the stretch and secretion of atrial neuropeptides leaves the left atrium far from being a simple transport chamber. The aim of this review is to provide an understanding of the left atrial physiology and its relation to disorders within the heart.

Increased inducibility of ventricular tachycardia and decreased heart rate variability in a mouse model for type 1 diabetes: effect of pravastatin.

Although a reduction in the high-frequency (HF) component of heart rate variability (HRV) is a major complication of diabetes and a risk factor for sudden death, its relationship to ventricular tachycardia (VT) is unknown. We developed a mouse model for the study of VT and its relationship to changes in HRV in the Akita type 1 diabetic mouse. Programmed ventricular stimulation of anesthetized mice demonstrated that Akita mice were more inducible for VT compared with wild-type mice: 78.6% versus 28.6% (P = 0.007). Optical mapping of perfused hearts demonstrated multifocal breakthroughs that occasionally gave rise to short-lived rotors consistent with focal initiation and maintenance of VT. Treatment of Akita mice with pravastatin, which had been previously shown clinically to decrease ventricular ectopy and to increase HRV, decreased the inducibility of VT: 36.8% compared with 75.0% with placebo treatment (P = 0.022). The HF fraction of HRV was reduced in Akita mice (48.6 ± 5.2% vs. 70.9 ± 4.8% in wild-type mice, P = 0.005) and was increased compared with placebo treatment in pravastatin-treated mice. Pretreatment of Akita mice with the muscarinic agonist carbamylcholine or the ß-adrenergic receptor blocker propranolol decreased the inducibility of VT (P = 0.001). In conclusion, the increased inducibility of focally initiated VT and reduced HF fraction in Akita mice were partially reversed by both pravastatin treatment and pharmacologic reversal of parasympathetic dysfunction. In this new animal model for the study of the pathogenesis of VT in type 1 diabetes, pravastatin may play a role in the prevention of VT by attenuating parasympathetic dysfunction.

Utilization of Over-the-Counter Painkillers Among Medical Students During Academic Examinations.

The utilization of over-the-counter (OTC) painkillers among medical students during academic exams has raised concerns about health risks and potential implications, including substance abuse and academic performance. This cross-sectional study aimed to estimate the prevalence of OTC painkiller utilization among medical students at Alfaisal University during academic exams. Additionally, the study explored and identified the factors that influenced the patterns of OTC painkiller utilization among these students. The study was conducted from January to May 2023, following approval from the Institutional Review Board. The research involved surveying medical students of different genders, nationalities, and academic years during examination periods. Out of 1,500 medical students, 194 participated, resulting in a response rate of approximately 13%. The study results revealed that 50.5% of medical students used OTC painkillers during exams. While there were no significant variations based on gender or nationality, the prevalence of OTC painkiller utilization varied significantly across academic years. During exam periods, the primary reason reported for using OTC painkillers was pain management. Additionally, some students mentioned using OTC painkillers to seek relaxation, improve sleep, enhance concentration, and stay alert. These insights shed light on the coping strategies practiced by students during high-stress academic periods. Most participants demonstrated familiarity with the guidelines for safe OTC painkiller utilization. Although the majority used painkillers infrequently or as needed, a subgroup reported increased utilization during exams. This finding highlights the importance of continuous monitoring and health education initiatives to prevent or address potential OTC painkiller abuse among medical students during exam periods. Ensuring the well-being of medical students is a priority, and appropriate measures should be employed to address any emerging concerns related to substance abuse. By addressing these issues proactively, educational institutions can promote a healthier academic environment during exam periods.

Prevalence of tobacco smoking among dental practitioners: A hospital-based study.

Background: Consumption of tobacco is a prevalent public health problem in Saudi Arabia and worldwide. It remains one of the world's leading causes of preventable premature death and a public health concern. We aim to Estimation the prevalence of tobacco smoking among dental practitioners working at the Security Forces Hospital in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted in one of the largest government hospitals in Riyadh using a self-administered questionnaire. The study targeted dental practitioners including; oral and maxillofacial surgeons, orthodontists, periodontists, prosthodontists, endodontists, pediatric dentists, restorative dentists, general dentists, dental hygienists, dental assistants, and dental lab technicians. The study data were analyzed using the SPSS statistical software package. Results: Overall, 74 dental practitioners completed the study questionnaire; 54.1% were females. The age of study participants ranged between 24 to 56 years, while their mean age was 33.84 years. The prevalence of current smokers among the respondents in was 25.67%. Of the participants, 9.45% were ex-smokers. Stress relief was the main reason for smoking (52.6%), followed by relaxation (31.6%). Most respondents agreed that dental practitioners should serve as role models (73%), and that health care practitioners should give advice or information about smoking cessation to patients (79.7%). Most participants had insufficient training about tobacco hazards (56.8%). Conclusion: The prevalence of tobacco smoking among dental practitioners included in this study was closer to that in previous studies. Furthermore, study participants lacked sufficient training about tobacco hazards and control.

Privacy Concerns Over the Use of Webcams in Online Medical Education During the COVID-19 Pandemic.

The emergence of the coronavirus diseases 2019 (COVID-19) pandemic has transformed traditional classroom education to online learning worldwide. Challenges to this sudden transformation include protecting student privacy while using online medical education services. Consequently, dealing with challenges to online medical education became a heated debate at Alfaisal University. This study aimed to determine the challenges of using webcams during online classes and the ensuing implications for medical education during the COVID-19 pandemic. A cross-sectional study was conducted during the 2020-2021 academic year. The study investigators developed and validated a self-administered online questionnaire that targeted preclinical and clinical medical students at Alfaisal University, which is a private not-for-profit academic institution that was founded in 2008. Alfaisal University consists of five colleges: Medicine, Business, Engineering, Pharmacy, and Science. A total of 319 medical students completed the study questionnaire, with a response rate of 25%. The median age of the study sample was 21 years, with 63.3% females; 78.1% were in preclinical (first to third) years and 21.9% were in clinical (fourth to fifth) years. Of the respondents, 76.5% reported not using webcams when communicating via social media and 64.3% preferred blended learning, i.e., a combination of face-to-face and online learning. An overwhelming majority (91.5%) of study respondents were against using webcams in online classes for reasons including privacy (88.4%) and anxiety (64.4%). Privacy was the main concern of study respondents. Information about online privacy, including information being collected and how it will be used, should be provided to the students. Effective strategies to improve online learning experiences and protect the privacy of students should be explored.

Challenges to Online Medical Education During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has impacted all aspects of our lives, including education and the economy, as we know it. Governments have issued stay-at-home directives, and as a result, colleges and universities have been shut down across the world. Hence, online classes have become a key component in the continuity of education. The present study aimed to analyze the impact of the COVID-19 pandemic on online education at the College of Medicine (COM) of Alfaisal University in Riyadh, Saudi Arabia. Between March and April 2020, we emailed a survey to 1,289 students and faculty members of the COM. We obtained 208 responses (16.1%); 54.8% of the respondents were females, and 66.8% were medical students; 14.9% were master's students, and 18.3% were faculty. Among the respondents, 41.8% reported having little or no online teaching/learning experience before the pandemic, and 62.5% preferred blending online and face-to-face instruction. The reported challenges to online medical education during the COVID-19 pandemic included issues related to communication (59%), student assessment (57.5%), use of technology tools (56.5%), online experience (55%), pandemic-related anxiety or stress (48%), time management (35%), and technophobia (17%). Despite these challenges, most of the respondents (70.7%) believed that the COVID-19 pandemic has boosted their confidence in the effectiveness of online medical education. Consequently, 76% of participants intended to integrate the online expertise garnered during the pandemic into their practice. In short, the modern study demonstrated a largely positive impact of the COVID-19 pandemic on online medical education.

Eligibility of Medical Students to Serve as Principal Investigator: An Evidence-based Approach.

Determining the eligibility of principal investigators (PIs) is a challenging task, especially at an academic institution. The prevailing practice within the academic community is not to grant PI status to students. There is a lack of studies that have investigated students' eligibility to serve as PI. This study aimed to explore the faculty and students' perceptions of the PI eligibility of medical students. A secondary objective was to assist the university in developing an evidence-based PI eligibility policy. To achieve the study aims, the investigators developed and validated a survey that targeted both faculty and students of Alfaisal University, College of Medicine (COM). In total, 53 faculty (four were administrators), and 135 medical students responded. The response rates were approximately 50% and 12% for faculty and students, respectively. Of the faculty, 62% reported that medical students are not PI eligible without the supervision of a faculty member. Of the students, 77% reported that they were not qualified to serve as PI. The results of the current study support the practice at most universities of not allowing medical students to serve as PI.

A Master of Public Health with a Concentration in Mass Gatherings Health.

Introduction The Kingdom of Saudi Arabia (KSA) is in a unique position and different from other nations that periodically host an event, such as the World Cup or the Olympics. The KSA is faced annually with millions of pilgrims coming from around the world to participate in the Hajj, Umrah, and Ziarah rituals. Continuously hosting such huge mass gatherings poses overwhelming challenges to the Saudi healthcare system. Consequently, an additional specialized cadre of qualified public health personnel is needed. The purpose of this article is to describe the establishment of an academic public health program that addresses this need. Materials & Methods In response to the dire need for public health specialists, a landmark project was launched in 2013 at Alfaisal University (AU). The project aimed to establish a Master of Public Health (MPH) program with a concentration in the health aspects of mass gatherings. The MPH program was created in collaboration with the United States-based Partners HealthCare International (PHI), the Saudi Global Center for Mass Gatherings Medicine (GCMGM) at the Ministry of Health (MOH), the Ministry of Education (MOE), and the Ministry of Hajj and Umrah (MOHU). A needs assessment was conducted to help in the program development. The needs assessment drew on the unpublished findings of an institutional review board (IRB)-approved anonymous market survey that was administered to prospective students of the MPH program. Results The needs assessment study revealed the need for an MPH program with concentrations in mass gatherings health, health policy and management, and biostatistics and epidemiology. Consequently, we designed an MPH program to include these three concentrations. In particular, the mass gatherings health concentration aimed at preparing qualified public health specialists to help manage risks to the Saudi public health system, to analyze health data, and to recommend policies associated with the continuous mass gatherings events. Challenges to program development included working with multiple governmental agencies, absence of a frame of reference to develop a program curriculum, a lack of qualified faculty, lengthy and tedious government approval procedures, and inadequate funding. After obtaining the required approvals, the MPH program with a concentration in mass gatherings health was inaugurated in the fall of 2016. This program is accredited by the Saudi government to prepare public health specialists trained and locally certified in mass gatherings health issues. Conclusions The public health experts of the AU have established what may be the first MPH program with a concentration in mass gatherings health. The main challenges to program development were identified, and appropriate actions to meet these challenges were taken. This innovative MPH produces certified specialists equipped with the analytical and policy-making tools necessary to continuously monitor and improve the public health aspects of mass gatherings. Besides, the program provides a frame of reference for the development of unique public health programs, not only in the KSA but worldwide.

A Hospital-based Study of the Prevalence and Usage of Complementary and Alternative Medicine Among Saudi Psychiatric Patients.

Introduction Complementary and alternative medicine (CAM) therapies, used singularly or in combination with more conventional therapies, are routinely used by citizens of the Kingdom of Saudi Arabia (KSA) for medical care or seeking wellness. However, the prevalence of CAM therapies among Saudi psychiatric patients is not yet documented. To better understand the importance of CAM in today's medical field, particularly within the KSA and for psychiatric patients, this descriptive study aims to characterize the use of CAM therapies by a sample of psychiatric patients in the KSA. Methods This cross-sectional hospital-based study describes the use of CAM therapies by Saudi psychiatric patients being treated at one of the largest government hospitals in the KSA. Using a pretested questionnaire, adult psychiatric patients waiting for their appointment or during their stay at a government hospital in Riyadh were interviewed regarding the use of CAM therapies after agreeing to participate. Results Forty-five adult psychiatric patients agreed to participate in this study. The average age of the participants in the study was 35. Of the participants, 62% were females, 91.1% were outpatients, and 44.4% were diagnosed with depression. Moreover, 82.2% of the participants reported using one or more types of CAM therapies within the past year to address mental illness. Of those who used CAM therapies, 62.2% did so to improve their quality of life; 59.5% did so for treatment, supportive treatment, or both, and 54.1% used CAM therapies to help control symptoms. The most frequent CAM therapies used by psychiatric patients were spiritual therapies such as Quran recitation; body therapies, mainly exercise; and mind therapies, mainly relaxation techniques. These CAM therapies were used mainly as treatments or supportive treatments for depression. Most of the participants who used CAM therapies were satisfied with the use of these therapies (75.7%). Finally, 45.9% of the participants had not discussed the use of CAM therapies with their doctors, primarily because of their reluctance to share private information, especially spiritual matters, with the treating physicians. Conclusions The study results suggest a high prevalence of CAM therapy use among Saudi adult psychiatric patients, as well as a high level of satisfaction with such therapies. However, since about half of the patients had not discussed the use of CAM therapies with their physicians, and since some of the CAM therapies may cause unfavorable interactions when used alongside certain medications or medical interventions, healthcare providers should be diligent about inquiring of their psychiatric patients any use of CAM therapies, not only during the initial visit but also during the follow-up visits as well.

Evaluation of a University's Institutional Review Board Based on Campus Feedback: A Cross-Sectional Study.

Introduction Maintaining research ethics within a university and monitoring the campus Institutional Review Board (IRB) are essential responsibilities not to be taken lightly. IRBs occasionally need to be reviewed to see that they, as well as researchers, are adhering to rules and regulations on ethics through their submission and review procedures. Since there are no established measures for assessing IRB quality, it is unclear how to determine whether IRBs are achieving their intended aims. This study used the feedback and input of campus members at a newly-established, private, non-profit university within the Kingdom of Saudi Arabia (KSA) to evaluate their campus IRB. Methods Following the university's IRB approval, and in close collaboration with the Saudi National Committee of Bioethics (NCBE), this cross-sectional study was conducted from February through May of 2019. Self-administered surveys were sent out via university emails to faculty and students at Alfaisal University in Riyadh of Saudi Arabia. The questions in the surveys included inquiries on participants' demographics, their familiarity with campus IRB research ethics, their satisfaction with IRB procedures, the challenges encountered during the IRB submission and review process, the effectiveness of a recent IRB-coordinated research ethics campaign, and any suggestions for IRB improvement. Surveys were sent to faculty members and students at five colleges on campus. Results Of the campus members who were sent surveys, 8% responded (175). Of those who responded, 29.7% had submitted at least one research proposal for IRB review during the past three years (2016-2019), and more than half of this group were satisfied with the IRB submission and review procedures. For those who had submitted at least one research proposal, respondents reported the more usual challenges that researchers tend to encounter, such as time-consuming and tedious IRB review processes and ambiguous IRB guidelines and regulations. The less typical IRB challenges that were reported, and that are unique to academia, include the IRB tendency to deny undergraduate student requests to serve as principal investigators of their research projects. Concerning IRB efforts to educate and train campus members on research ethics, only 26.3% of the participants were aware of the recently performed research ethics campaign, and 7.6% of the participants attended the end-of-campaign workshop. Of those who attended the workshop, 76.9% reported that the campaign and workshop effectively met their expectations. Conclusions  This study revealed several issues encountered by university faculty and students seeking campus IRB approval for their research projects. The main academia-specific challenge was over whether undergraduate students could serve as PIs for research projects, and a universal one was that they find the IRB process to be very time-consuming and tedious, which is a situation that has already been relayed in several other articles on IRB issues. About two-thirds of respondents reported a lack of familiarity with the topic of research ethics. This challenge makes it clear that information on research ethics is not effectively reaching enough campus members in the busy environment of academia.

QRS/T-wave and calcium alternans in a type I diabetic mouse model for spontaneous postmyocardial infarction ventricular tachycardia: A mechanism for the antiarrhythmic effect of statins.

BACKGROUND: The incidence of sudden arrhythmic death is markedly increased in diabetics. OBJECTIVE: The purpose of this study was to develop a mouse model for postmyocardial infarction (post-MI) ventricular tachycardia (VT) in the diabetic heart and determine the mechanism of an antiarrhythmic effect of statins. METHODS: ECG transmitters were implanted in wild-type (WT), placebo, and pravastatin-treated type I diabetic Akita mice. MIs were induced by coronary ligation, and Ca2+ transients were studied by optical mapping, and Ca2+ transients and sparks in left ventricular myocytes (VM) by the Ionoptix system and confocal microscopy. RESULTS: Burst pacing of Akita mouse hearts resulted in rate-related QRS/T-wave alternans, which was attenuated in pravastatin-treated mice. Post-MI Akita mice developed QRS/T-wave alternans and VT at 2820 ± 879 beats per mouse, which decreased to 343 ± 115 in pravastatin-treated mice (n = 13, P <.05). Optical mapping demonstrated pacing-induced VT originating in the peri-infarction zone and Ca2+ alternans, both attenuated in hearts of statin-treated mice. Akita VM displayed Ca2+ alternans, and triggered activity as well as increased Ca2+ transient decay time (Tau), Ca2+ sparks, and cytosolic Ca2+ and decreased SR Ca2+ stores all of which were in part reversed in cells from statin treated mice. Homogenates of Akita ventricles demonstrated decreased SERCA2a/PLB ratio and increased ratio of protein phosphatase (PP-1) to the PP-1 inhibitor PPI-1 which were reversed in homogenates of pravastatin-treated Akita mice. CONCLUSION: Pravastatin decreased the incidence of post-MI VT and Ca2+ alternans in Akita mouse hearts in part by revering abnormalities of Ca2+ handling via the PP-1/PPI-1 pathway.

Local Anesthesia With Monitored Anesthesia Care vs General Anesthesia in Thyroidectomy: A Randomized Study.

BACKGROUND: Early in the 20th century, thyroid surgery was performed using local anesthetic techniques. When general anesthesia became safer, surgeons started performing thyroidectomy exclusively under general anesthesia. However, recent descriptions of thyroidectomy under local anesthesia claim similar results to thyroidectomy under general anesthesia. Surgery conducted under local anesthesia can result in early discharge, ie, a hospital stay of less than 8 hours. HYPOTHESIS: Thyroidectomy can be performed under local anesthesia with monitored anesthesia care (MAC) with results similar to general anesthesia in an outpatient or inpatient surgery setting. DESIGN: A prospective randomized study comparing local anesthesia with MAC vs general anesthesia in adult patients undergoing thyroidectomy in a potential outpatient setting, defined as same-day discharge. Patients were excluded if they were not able to receive local or general anesthesia. In addition, we performed an outcome evaluation of the use of local anesthesia with MAC for thyroidectomy and the use of outpatient surgery for thyroidectomy. We compared 58 consecutive thyroidectomies performed prior to the study with 58 consecutive thyroidectomies performed after the study. SETTING: A 486-bed university-affiliated hospital. RESULTS: Fifty-eight patients undergoing thyroidectomy received random assignment: 29 to local anesthesia with MAC and 29 to general anesthesia under study protocol. Fifty-one surgical procedures (88%) were completed as outpatient surgery. No significant differences were found between the 2 study groups in demographics, postoperative adverse symptoms, complications, hospital admission, or patient satisfaction. Patients in the general anesthesia group spent, on average, more time postoperatively than patients in the group that received local anesthesia with MAC in the outpatient surgery center until same-day discharge (P = .02). When compared before the study, we found a significant increase after the randomized study in the use of local anesthesia with MAC (P<.001) and outpatient thyroidectomies (P<.001). CONCLUSIONS: Thyroidectomy can be performed in the studied patient population under either general anesthesia or local anesthesia with MAC, expecting similar operative results, clinical results, and patient satisfaction. In addition, local anesthesia with MAC can reduce the postoperative time spent in an outpatient surgery setting with potential health care cost savings.

Thromboembolic events in patients with inflammatory bowel disease.

BACKGROUND/AIMS: Inflammatory bowel disease (ulcerative colitis and Crohn's disease) is characterized by a chronic inflammatory condition, and is accompanied by abnormalities in coagulation and a hyper-coagulable state. This study was conducted to examine the risk factors for developing Thromboembolic Events in Inflammatory Bowel Disease (IBD) in a population with prevalent consanguinity. PATIENTS AND METHODS: Patients with a definitive diagnosis of IBD who were seen in the gastroenterology clinic of King Khalid University Hospital (Riyadh, Saudi Arabia) from 2010- to 2012, were asked to participate in this prospective cohort study, and were followed for one 1 year. Data was collected using specifically designed case report forms (CRF) by trained research personnel. RESULTS: A total of 100 Saudi patients with IBD were studied. There were 51 (51%) women and the mean ± standard deviation (SD) age of the group was 31.24 ± 10.78 years. Those with Crohn's disease constituted 72% of the patients, and 28% had ulcerative colitis. Eight patients (8%) had at least one Thrombotic Event ([six deep venous thrombosis (DVT), and two pulmonary embolism (PE)]. Family history of deep venous thrombosis was present in 5%, and family history of pulmonary embolism (PE) in 4% of the patients. After adjusting for age and gender, a family history of Thrombotic event was identified as to be the only statistically significant predictor of thrombosis in IBD patients (RR = 9.22, 95% CI: 2.10--40.43). CONCLUSION: In a population with high consanguinity, Thromboembolic events (DVT and PE) had a prevalence of 8% among IBD patients, positive family history of pulmonary embolism was a predictor of thrombosis. Further studies are needed to explore the role of genetic factors in this population.

Effect of freezing rate for cryopreservation of Persian sturgeon (Acipenser persicus) spermatozoa.

This study examined the effect of freezing rate (-10 °C, -15 °C, -20 °C, -30 °C, and -40 °C/min) on motility parameters, rates of fertilization and hatching, ATP content, and indices of oxidative stress including thiobarbituric acid reactive substances and carbonyl derivatives of proteins in Persian sturgeon (Acipenser persicus) sperm. After sampling, sperm was diluted in an extender composed of 23.4-mM sucrose, 0.25-mM KCl, and 30-mM Tris-HCl, pH 8.0, containing 10% methanol and subsequently frozen in a programmable freezer. For postthaw sperm that were frozen at a rate of -40 °C/min, sperm motile duration (134 ± 27.01 seconds), sperm motile percent (60 ± 4.1%), fertilizability (72 ± 8.36% for fertilization rate and 65 ± 7.58% for hatching rate), and ATP content (4.8 ± 0.57 nmol/10(8) sperm) were significantly higher than for sperm frozen at any of the four slower rates (P < 0.05). Moreover, sperm cryopreserved using the fastest freezing rate had significantly lower levels of thiobarbituric acid reactive substances (0.5 ± 0.05 nmol/10(8) sperm) and carbonyl derivatives of proteins (41.3 ± 4.9 nmol/10(8) sperm) than sperm cryopreserved using all other freezing rates (P < 0.05). In addition, there is a significant difference (P < 0.05) between fresh sperm and the recovery of cryopreserved Persian sturgeon sperm using programmable freezing with -40 °C/min being the optimal freezing rate among those tested.

Improving Medication Reconciliation compliance at admission: A single department's experience.

BACKGROUND AND OBJECTIVES: The objective of this research is to improve compliance of the medication reconciliation process at the time of patient admission in the Department of Pediatrics at King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia using an innovative evidence-based approach. MATERIALS AND METHODS: Most of the recent efforts at our institution to revamp the medication reconciliation process have failed. Thus, we implemented an innovative evidence-based approach to improve the compliance of the reconciliation process at admission. This approach focused on the Department of Pediatrics at King Faisal Specialist Hospital and Research Centre (KFSH&RC). We established specific educational and monitoring programs that were run over a two-month period, from June to July 2015. The educational program consisted of focused hands-on daily interactive training sessions presented to a small group of residents, i.e., 5-6 residents per session, for a period of one week. One resident was identified as a "Super-User" to provide ongoing support for the other residents involved in the process. A close monitoring process was also implemented, which included daily follow up and encouragement from three assigned consultants. In addition, periodic independent audit report results prepared by Healthcare Information Technology Affairs (HITA) were communicated to the Department of Pediatrics regarding physician compliance in the medication reconciliation process. RESULTS: Physician compliance for admission medication reconciliation documentation in ICIS ranged from (0-15%) between the first quarter of 2012 and the first quarter 2015, we designated the official hospital audit for the first quarter of 2015 as a baseline audit report. Between the first quarter of 2012 and 2015, the physician compliance for admission medication reconciliation was ranged between 0 to 15% according to the official hospital audit. We implemented our initiative during the months of June and July 2015. During that time, there was a gradual improvement in the number of admission medication reconciliations reported by the independent audits of our general Pediatrics Ward (B1), which represents the majority of pediatric admissions. The 57% of 26 patients had medication reconciliation completed by the first report dated 16 June 2015. This percentage improved to 92% out of a total of 13 patients at the last report on 12 July 2015. This consistent improvement also occurred in other areas where pediatric patients were admitted including the B3-1 (from 88% to 90%), the NICU 1 (from 83% to 100%) and the NICU 2 (from 90% to 100%). CONCLUSIONS: By structuring and implementing intensive educational and monitoring programs, a marked improvement in the compliance of medication reconciliation at the time of admission for the pediatric patient population was achieved. We believe that our department-based results would be generalizable if a similar hospital-wide programme was to be rigorously implemented.