Smell loss associated with SARS-CoV-2 is not clinically different from other viruses: a multicenter cohort study.

BACKGROUND: Although the COVID-19 pandemic has increased the prevalence of cases with olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on olfactory symptoms. METHODS: Patients with sudden smell loss were recruited in a multicenter prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to perform a PCR-based respiratory viral panel were collected at first visit (day 0) and 30 and 60 days after recruitment. RESULTS: 188 of 213 patients presented positive test result for SARS-CoV-2, among which 65 were co-infected with other respiratory viruses (e.g., rhinovirus, enterovirus, and parainfluenza). 25 had negative test results for SARS-CoV-2. Patients in both SARSCoV-2 and non-SARS-CoV-2 groups had objective anosmia (less than 2 points according to the psychophysical olfactory CCCRC) at day 0, with no significant difference between them. Both groups had significant smell scores improvement after 30 and 60 days, with no difference between them. Co-infection with other respiratory viruses, and SARS-CoV-2 viral load did not impact olfactory scores. CONCLUSION: Patients with sudden smell loss associated with SARS-CoV-2 and other respiratory viruses had similar presentation, with most participants initiating with anosmia, and total or near total recovery after 60 days. SARS-CoV-2 viral load and co-infections with other respiratory viruses were not associated with poorer olfactory outcomes.

Mindfulness-based intervention as a symptom management strategy in patients with end-stage renal disease: A controlled clinical trial.

AIM: The study's purpose was to examine the effect of mindfulness-based intervention (MBI) on physical and psychological symptoms in patients with end-stage renal disease (ESRD) in Jordan. METHODS: A repeated-measure randomized control study was conducted in a haemodialysis unit in Jordan between April 2023 and July 2023. Participants (N = 61) were selected using convenience sampling and then randomly assigned into experimental and control groups. The experimental group performed 30-min MBI, three times a week for 8 weeks during haemodialysis sessions. The Depression, Anxiety and Stress Scale-21 and the Patient Health Questionnaire-15 were used to measure the outcomes at baseline, after 5 weeks of the intervention and at the end of the intervention. RESULTS: Mixed-model repeated-measure ANOVAs revealed that the experimental group showed significantly lower levels of stress, depression and physical symptoms than the control group over time. Within-subject repeated-measure ANOVAs revealed that, in the experimental group, physical symptoms improve significantly over the three points of time. However, significant reductions in psychological symptoms occurred 5 weeks after initiating the intervention, but there was no further significant improvement at the end of the intervention. CONCLUSION: The study supports the integration of MBI as a symptom management strategy into nursing care plans of patients with ESRD. TRIAL REGISTRATION: Clinical trial.gov; registration ID: NCT06064708.

Vaginal collagen I and III changes after carbon dioxide laser application in postmenopausal women with the genitourinary syndrome: a pilot study.

OBJECTIVE: The aim of the study was to evaluate the clinical response and collagen remodeling in the vaginal wall after three sessions of carbon dioxide (CO2) laser application. METHODS: Fourteen postmenopausal women with vulvovaginal atrophy, aged 45-65 years and sexually active, were evaluated with clinical questionnaires, gynecological examinations and histological techniques before and after 20 weeks of treatment (ClinicalTrials.gov NCT03939078). Treatment consisted of 3-monthly sessions of the CO2 laser. Clinical questionnaires included the Vaginal Health Index, the Female Sexual Function Index and the International Consultation on Incontinence Questionnaires Short Form. Biopsies were taken from the lateral vaginal wall at week 0 (left wall) and week 20 (right wall). Tissue samples were stained with hematoxylin and eosin, Periodic Acid-Schiff, Picrosirius Red Stain and Orcein dyes. Immunohistochemical study was used to quantify collagens I and III in the samples. RESULTS: The mean age was 54.4 ± 4.5 years, and the average time of amenorrhea was 7.6 ± 5.1 years. The Female Sexual Function Index and the Vaginal Health Index Score values increased while the International Consultation on Incontinence Questionnaire Short Form score decreased after the programmed treatment. There was no significant change in vaginal pH. Histological studies showed increases in the total and superficial epithelial cell layers, and type III collagen fibers (from 10.86 ± 7.66 to 16.87 ± 3.96, p < 0.05), and immunohistochemical studies confirmed the significant increase in collagen III. CONCLUSION: Histological findings revealed epithelial atrophy reversal and collagen remodeling of the vaginal wall. Immunohistochemical analysis showed an increase in collagen type III fibers.

Mortality Rate, Demographics, and Clinical Attributes of Patients Dying in the Intensive Care Unit of a Comprehensive Cancer Center in Jordan: A Descriptive Study.

Very little is known about the provision of or the need for palliative care in the Middle East, including Jordan. This study investigated the mortality rate, demographics, and clinical attributes of patients with cancer who had died in the intensive care unit (ICU) of a national cancer center over a 3-year period in Jordan. We reviewed the records of 661 patients who had died and found that the majority of the people were terminally ill at the time of admission (had metastatic cancer, multisystem organ dysfunction, and seriously ill). This approach differs from the usual practice worldwide in which it is uncommon to admit patients with cancer to the ICU at the end of life. Improving end-of-life care in the ICUs in Jordan requires further exploration of the cultural context in which end-of-life care practice occurs in Jordan and developing a palliative care approach that fit with the Islamic and Arabic culture.

Glycaemic stability and length of stay: Tight versus conventional intraoperative glycaemic control protocols among patients with diabetes mellitus undergoing coronary artery bypass graft surgery.

BACKGROUND: Intraoperative glycaemic stability and control among patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) surgery have been a major concern. The current study aimed to compare the effect of tight glycaemic control and conventional glycaemic control on glycaemic stability and length of stay (LOS) among diabetic patients undergoing CABG surgery. METHODS: This study utilised a randomised control trial design among a convenience sample of 144 patients. Participants were randomly assigned to either the tight or conventional glycaemic control groups. The repeated measures analysis of variance (ANOVA) test and an independent samples t test were used to assess the variations in blood glucose (BG) level and LOS based on insulin therapy type. RESULTS: Patients who received the tight glycaemic control protocol had significantly more consistent and lower mean intraoperative BG levels than did patients who received the conventional glycaemic control protocol. No statistically significant differences in hospital LOS in days were identified between the two groups. CONCLUSION: Healthcare providers, including physicians and nurses, should consider using tight glycaemic control therapy among patients undergoing coronary artery bypass graft (CABG) surgery. This may lead to increased BG level consistency and stability and lower mean intraoperative BG level across time.

Pooled safety analysis of baricitinib in adult patients with atopic dermatitis from 8 randomized clinical trials.

BACKGROUND: Janus kinase (JAK) inhibition is a new mode of action in atopic dermatitis (AD); clarity about drug class safety considerations in the context of AD is important. Baricitinib, an oral, reversible, selective inhibitor of JAK1/JAK2, is in late-stage development for adult patients with moderate-to-severe AD. OBJECTIVE: To report pooled safety data for baricitinib in patients with moderate-to-severe AD in the clinical development program including long-term extension (LTE) studies. METHODS: This analysis included patient-level safety data from six double-blinded, randomized, placebo-controlled studies (one phase 2 and five phase 3), one double-blinded, randomized, LTE study and one open-label LTE study, reported in three data sets: placebo-controlled, 2-mg - 4-mg extended and All-bari AD. Safety outcomes include treatment-emergent adverse events, adverse events of special interest and abnormal laboratory changes. Proportions of patients with events and incidence rates were calculated. RESULTS: Data were collected for 2531 patients who were given baricitinib for 2247 patient-years (median duration 310 days). The frequency of serious infections, opportunistic infections and conjunctival disorders was low and similar between treatment groups in the placebo-controlled period. The most common serious infections were eczema herpeticum [n = 11, incidence rates (IR) = 0.5], cellulitis (n = 6, IR = 0.3) and pneumonia (n = 3, IR = 0.1). There were four opportunistic infections (IR = 0.2). No malignancies, gastrointestinal perforations, positively adjudicated cardiovascular events or tuberculosis were reported in the placebo-controlled period in baricitinib-treated patients. Frequency of herpes simplex was higher in the 4-mg group (6.1%) vs. the 2-mg (3.6%) and placebo group (2.7%); IRs in the extended data set (2-mg IR = 9.6; 4-mg IR = 14.5) were lower vs. the placebo-controlled data set (2-mg IR = 12.4; 4-mg IR = 21.3). In the All-bari AD data set, there were two positively adjudicated major adverse cardiovascular events (2-mg group): two venous thrombosis events (4-mg group) and one death. CONCLUSION: This integrated safety analysis in patients with moderate-to-severe AD confirms the established safety profile of baricitinib.

Smartphone-based single-channel speech enhancement application for hearing aids.

This work presents a single-channel speech enhancement (SE) framework based on the super-Gaussian extension of the joint maximum a posteriori (SGJMAP) estimation rule. The developed SE algorithm is an open-source research smartphone-based application for hearing improvement studies. In this algorithm, the SGJMAP-based estimation for noisy speech mixture is smoothed along the frequency axis by a Mel filter-bank, resulting in a Mel-warped frequency-domain SGJMAP estimation. The impulse response of this Mel-warped estimation is obtained by applying a Mel-warped inverse discrete cosine transform (Mel-IDCT). This helps in filtering out the background noise and enhancing the speech signal. The proposed application is implemented on an iPhone (Apple, Cupertino, CA) to operate in real time and tested with normal-hearing (NH) and hearing-impaired (HI) listeners with different types of hearing aids through wireless connectivity. The objective speech quality and intelligibility test results are used to compare the performance of the proposed algorithm to existing conventional single-channel SE methods. Additionally, test results from NH and HI listeners show substantial improvement in speech recognition with the developed method in simulated real-world noisy conditions at different signal-to-noise ratio levels.

Tight glycaemic control and surgical site infections post cardiac surgery: a systematic review.

OBJECTIVE: Surgical site infection (SSI) is one of the most serious potential complications post cardiac surgery among patients with diabetes and has a number of adverse health outcomes. The literature shows discrepancies regarding the effect of different glycaemic control protocols on reducing adverse health outcomes including SSIs. The aim of this study was to conduct a systematic review that investigated the effect of the optimal range of tight glycaemic control protocols using a continuous insulin infusion on reducing the incidence of SSIs in adult patients with diabetes undergoing cardiac surgery. METHOD: A systematic review was conducted following the PRISMA statement and guidelines. Search terms were used to identify research studies published between 2000 and 2019 across five key databases, including CINAHL, Medline, PubMed, Cochrane Database and Google Scholar. RESULTS: A total of 12 studies met the review inclusion criteria. The reviewed literature tended to support the implementation of a tight glycaemic control protocol, particularly in the postoperative phase, that demonstrated fewer potential complications associated with cardiac surgery. On the other hand, the literature also supported the application of a moderate glycaemic control protocol in the intraoperative phase to obtain better glycaemic stability with fewer potential complications among those patients with diabetes undergoing cardiac surgery. CONCLUSION: This analysis concludes that tight glycaemic control is more effective than moderate glycaemic control intraoperatively in terms of glycaemic stability among patients with diabetes undergoing cardiac surgery. Results also emphasised the importance of time-based protocol implementation to ensure better health outcomes and better quality of care for patients.

Nurses' Knowledge, Perception, and Practice of Discharge Planning in Acute Care Settings.

BACKGROUND: Unsuccessful discharge planning (DP) may lead to undesirable health consequences among patients after discharge from the hospital. PURPOSE: The aims of this study were to assess nurses' knowledge, perception, and practice of DP in acute care settings and identify significant predictors for nurses' practice toward DP. METHODS: The study had a descriptive correlational cross-sectional design. Three questionnaires about knowledge, perception, and nurses' activities toward DP were used. Nurses (n = 117) were recruited from 3 Jordanian hospitals. RESULTS: The level of nurses' knowledge toward DP was very low to low. Slightly more than half (52.1%) of nurses had a negative perception toward DP and about 50% had poor practices related to DP. Nurse-to-patient ratio and perception of nurses were significant predictors for nurses' practice toward DP. CONCLUSION: The reinforcement of a positive perception toward DP among nurses working in acute care settings may lead to better health outcomes among patients after discharge from hospital.

Efficient two-microphone speech enhancement using basic recurrent neural network cell for hearing and hearing aids.

This work presents a two-microphone speech enhancement (SE) framework based on basic recurrent neural network (RNN) cell. The proposed method operates in real-time, improving the speech quality and intelligibility in noisy environments. The RNN model trained using a simple feature set-real and imaginary parts of the short-time Fourier transform (STFT) are computationally efficient with a minimal input-output processing delay. The proposed algorithm can be used in any stand-alone platform such as a smartphone using its two inbuilt microphones. The detailed operation of the real-time implementation on the smartphone is presented. The developed application works as an assistive tool for hearing aid devices (HADs). Speech quality and intelligibility test results are used to compare the proposed algorithm to existing conventional and neural network-based SE methods. Subjective and objective scores show the superior performance of the developed method over several conventional methods in different noise conditions and low signal to noise ratios (SNRs).

Association of nurses' level of knowledge and attitudes to ageism toward older adults: Cross-sectional study.

This study aims to examine how the sociodemographic and professional characteristics of nurses in Jordan correlate with their levels of knowledge, attitudes, and ageism toward older adults. Ageism has not been studied in Jordan as it pertains to nurses, so a descriptive, correlational, cross-sectional design, with a convenience sample of 317 Jordanian nurses, using the Fact on Aging Quiz 1, Fraboni Scale of Ageism, and Relating to Older People Evaluation was conducted in January to February 2019. Significant ageism was found, and differences in knowledge, attitudes, and negative ageism vary among nurses by sociodemographic/professional characteristics. Knowledge and attitudes toward older adults significantly correlate with negative ageism which is associated with poor health outcomes for older adults. Our findings reveal that even in a country with high religious observance and close family ties, ageism exists in healthcare settings because of nurses' poor knowledge and attitudes toward older adults. These findings have implications for nursing education, clinical practice, and health policy. Changes across these sectors based on the findings may contribute to reducing ageist practices and improving older adult health outcomes.

PGAP3-related hyperphosphatasia with mental retardation syndrome: Report of 10 new patients and a homozygous founder mutation.

BACKGROUND: Hyperphosphatasia with mental retardation syndrome (HPMRS) is caused by recessive mutations in genes involved in the glycosylphosphatidylinsitol pathway, including PGAP3. MATERIALS AND METHODS: We describe 10 patients from 8 Egyptian families presenting with developmental delay, severe intellectual disability, distinct facial dysmorphism and increased alkaline phosphatase. Sanger sequencing of PGAP3 was performed. RESULTS: Eight patients had cleft palate, 4 had postnatal microcephaly and 5 had seizures. Neuro-imaging findings showed thin corpus callosum in 9 patients, mild ventriculomegaly in 3 patients and variable degrees of cerebellar vermis hypoplasia in 4 patients, a finding not previously reported in patients with HPMRS. Additional manifestations included double row teeth, hypogenitalism and congenital heart disease. Biallelic loss of function mutations in the PGAP3 gene were detected in all patients. Nine patients were homozygous for the c.402dupC (p.M135Hfs*28) mutation strongly suggesting a founder effect. On the other hand, 1 patient had a novel mutation, c.817_820delGACT (p.D273Sfs*37). CONCLUSION: This is the largest series of patients with HPMRS from same ethnic group. Our results reinforce the distinct clinical and facial features of PGAP3-related HPMRS which are the clue for targeted genetic testing. Moreover, we present additional unreported clinical and neuro-imaging findings and a novel mutation thus expanding the phenotypic and mutational spectrum of this rare disorder.

Hypermanganesemia with dystonia, polycythemia and cirrhosis in 10 patients: Six novel SLC30A10 mutations and further phenotype delineation.

Biallelic mutations in the SLC30A10 gene cause an inborn error of Mn metabolism characterized by hypermanganesemia, polycythemia, early-onset dystonia, and liver cirrhosis (HMDPC). To date, only 14 families from various ethnic groups have been reported. Here, we describe 10 patients from 7 unrelated Egyptian families with HMDPC. Markedly elevated blood Mn levels, the characteristic basal ganglia hyperintensity on T1-weighted images, and variable degrees of extrapyramidal manifestations with or without liver disease were cardinal features in all patients. Eight patients presented with striking early diseased onset (≤2 years). Unexpectedly, early hepatic involvement before the neurological regression was noted in 3 patients. Mutational analysis of SLC30A10 gene revealed 6 novel homozygous mutations (c.77T > C (p.Leu26Pro), c.90C > G (p.Tyr30*), c.119A > C (p.Asp40Ala), c.122_124delCCT (p.Ser41del), c.780_782delCAT (p.Iso260del) and c.957 + 1G > C). Treatment using 2,3 dimercaptosuccinic acid as a manganese chelating agent showed satisfactory results with improvement of biochemical markers, hepatic manifestations and relative amelioration of the neurological symptoms. Our findings present a large cohort of patients with HMDPC from same ethnic group. The majority of our patients showed severe and early presentation with clear phenotypic variability among sibship. Moreover, we extend the phenotypic and mutational spectrum and emphasize the importance of early diagnosis and treatment of this potentially fatal disorder.

Surgical site infections after craniotomy: a matched health-care cost and length of stay study.

OBJECTIVE: To assess the extra health-care costs and length of stay resulting from surgical site infection (SSI), as well as to identify the most frequent aetiological microorganisms of SSIs among Jordanian craniotomy surgery patients. METHOD: A retrospective, descriptive, correlational and nested 1:1 matched case-control design was used. A computerised list of patients, who underwent surgery between May 2009 and March 2015, was generated in the targeted hospital. A final bill for every selected patient was also determined. Patients were divided equally into two groups: patients with an SSI and patients without an SSI. RESULTS: A total of 64 patients were recruited. The SSI-group had a significant higher mean health-care cost of $7,899.08 (p=0.001) and a longer stay in hospital (mean additional days: 23.17) than the non-SSI group. Furthermore, Acinetobacter baumannii and Staphylococcus aureus were determined as the most predominant causative agents of SSI, at 39.1% and 26.1% of SSI patients, respectively. CONCLUSION: The results of this study can be considered as a baseline for national benchmarking to evaluate the quality of care provided to targeted patients. This study should encourage nurse administrators to adopt protocols and strategies that promote infection control measures, as well as to develop new methods of surveillance on universal precautions adherence. This may limit pathogen contamination in the surgical wound, shorten length of stay and decrease health-care costs.

Differences Between Schizophrenic and Normal Subjects Using Network Properties from fMRI.

Schizophrenia has been proposed to result from impairment of functional connectivity. We aimed to use machine learning to distinguish schizophrenic subjects from normal controls using a publicly available functional MRI (fMRI) data set. Global and local parameters of functional connectivity were extracted for classification. We found decreased global and local network connectivity in subjects with schizophrenia, particularly in the anterior right cingulate cortex, the superior right temporal region, and the inferior left parietal region as compared to healthy subjects. Using support vector machine and 10-fold cross-validation, nine features reached 92.1% prediction accuracy, respectively. Our results suggest that there are significant differences between control and schizophrenic subjects based on regional brain activity detected with fMRI.

Alternative approaches in formulating floating hollow tablets via sublimation technique; a platform tailored drug release profile.

The aim of this study was to formulate floating hollow tablets of salbutamol sulphate with a platform tailored drug release profile to attain a controllable drug release. Eight formulations (F1-F8) were prepared using sublimation technique. L-menthol was directly compressed as sublimable core followed by compression coating of hydroxypropylmethyl cellulose (HPMC-K15M) or polyethylene oxide (PEO-WSR301) as release retarding polymer coat. Tablets were then subjected to heat to allow sublimation of the core. The effect of polymer type and that of different drug coat/core distribution on swelling and drug release profile was studied. FTIR and DSC revealed the absence of any drug-excipients interaction. Tablets showed a hollow morphology, resulting in low density tablets that floated for over 24 hours without lag time. Moreover, different drug coat/core distribution resulted in controllable release profiles. Based on these results, an optimum drug release behavior was recorded for HPMC-based hollow tablets consisting of 2:1 drug coat/core distribution ratio (F4), revealing a zero order drug release for over 14 hours. Furthermore, F4 showed no changes in drug content, floating properties and drug release profile upon exposure to accelerated stability conditions.

Validation of two real-time PCRs targeting the PE-PGRS 20 gene and the region of difference 4 for the characterization of Mycobacterium bovis isolates.

This study aimed to develop and validate real-time PCR for the diagnosis of Mycobacterium bovis isolates. Two hundred and seventy-four M. bovis isolates and 156 M. tuberculosis isolates were tested. Both qPCRs amplified all of the 274 M. bovis samples, but none of the 156 M. tuberculosis samples. The qPCR for PE-PGRS 20 had 91% efficiency and a detection limit of 0.32 ng (sensitivity and specificity for qPCR "Mbovis.100" were 99.64 and 100%, respectively). The qPCR for RD4 had 100% efficiency, and a detection limit of 4 pg (diagnostic sensitivity and specificity were 100 and 100%. The qPCR tests were performed using 4 extraction sets, 3 qPCR kits, and with a range of equipment; yet, all combinations produced similar results in a diagnostic test, demonstrating the robustness of this method. The techniques proved to be efficient, robust, sensitive, and specific for the diagnosis of M. bovis.

Effect of bovine colostrum intake on growth, reproductive parameters and survival in red kids.

The aim of this study is to evaluate the efficacy of frozen Azawak colostrum supplementation on body weight (BW), average daily gain (ADG), reproductive parameters (mean age at first parturition, fertility, fecundity, prolificacy) and mortality rate among red kids. The study was conducted at the goat farm secondary centre of Maradi in Niger from September 2010 to September 2011. The control animals (n = 20) were left with their mother, while the treatment animals (n = 20) received in addition 50 ml/animal/day of bovine colostrum at birth and 15 ml/animal/day from d2 to d15. Weight was measured weekly from birth to d365. Mortalities were also recorded over the same period. For reproductive parameters, observations began at weaning (d197). Growth rate was higher (p < 0.001) in supplemented animal, and the treatment effects on ADG were observed up to 150 day after the end of supplementation. A similar long-lasting trend was also observed in relation to the mortality rate (25% for ColG vs. 55% for ConG; p = 0.05). The age at first kidding tended to be lower in the treated group (13.8 ± 0.7 vs. 14.1 ± 0.8 month; p < 0.1). In conclusion, mild bovine colostrum supplementation induces a long-lasting positive impact on growth rate and to a lower extent on reproduction parameters and survival rate.

Evaluation of resuscitation systems in the Democratic Republic of Congo: A narrative review.

Introduction: Limited data exists regarding cardiovascular diseases (CVDs) and related emergencies such as out-of-hospital cardiac arrest (OHCA) in low- and middle-income countries (LMICs). The recent burden of disease report indicates a rising prevalence of CVDs in these settings like the Democratic Republic of Congo (DRC), likely associated with acute complications. Achieving improved outcomes necessitates resilient healthcare systems, including adequate emergency care and resuscitation systems. This study aims to characterize the current state of resuscitation systems in the DRC, contributing to the discourse on the burden of CVDs in LMICs and advocating for context-appropriate interventions to develop and reinforce these systems. Methods: A narrative review utilizing the modified survival framework of the Global Resuscitation Alliance was conducted. It encompassed the country's CVD epidemiological data, healthcare components, and emergency care system. Results: Analysis of limited available data revealed an underdeveloped and inadequately resourced healthcare system in the country, particularly its early-stage emergency care component. While specific data on out-of-hospital cardiac arrests were lacking, crucial components of the survival chain necessary for improved post-arrest outcomes were found to be largely deficient. Community-based first aid knowledge and practice were inadequate, the availability of automated external defibrillators (AEDs) and integrated ambulance services were either absent or insufficiently developed, and facility-based resuscitation capacity was predominantly in its infancy. Nonetheless, optimism is warranted due to recent government decisions to increase total health expenditure and progressively implement Universal Health Coverage. Conclusion: Resuscitation systems in the DRC are largely non-existent, reflecting the country's underdeveloped healthcare system, particularly in emergency care. Urgent action is needed to develop and reinforce context-appropriate resuscitation systems to address the growing burden of CVD-related emergencies in LMICs.