Identifying predictors of adverse outcomes after termination of seclusion in psychiatric intensive care units.

BACKGROUND: Seclusion is a restrictive practice that many healthcare services are trying to reduce. Previous studies have sought to identify predictors of seclusion initiation, but few have investigated factors associated with adverse outcomes after seclusion termination. AIMS: To assess the factors that predict an adverse outcome within 24 h of seclusion termination. METHOD: In a cohort study of individuals secluded in psychiatric intensive care units, we investigated factors associated with any of the following outcomes: actual violence, attempted violence, or reinitiation of seclusion within 24 h of seclusion termination. Among the seclusion episodes that were initiated between 29 March 2018 and 4 March 2019, we investigated the exposures of medication cooperation, seclusion duration, termination out of working hours, involvement of medical staff in the final seclusion review, lack of insight, and agitation or irritability. In a mixed-effects logistic regression model, associations between each exposure and the outcome were calculated. Odds ratios were calculated unadjusted and adjusted for demographic and clinical variables. RESULTS: We identified 254 seclusion episodes from 122 individuals (40 female, 82 male), of which 106 (41.7%) had an adverse outcome within 24 h of seclusion termination. Agitation or irritability was associated with an adverse outcome, odds ratio 1.92 (95% CI 1.03 to 3.56, P = 0.04), but there was no statistically significant association with any of the other exposures, although confidence intervals were broad. CONCLUSIONS: Agitation or irritability in the hours preceding termination of seclusion may predict an adverse outcome. The study was not powered to detect other potentially clinically significant factors.

Prevalence of nasal obstruction and its impact on quality of life in Saudi Arabia.

Purpose/Background: Nasal obstruction is a significant issue influencing the patient's quality of life. Chronic nasal obstruction is frequently associated with other symptoms such as headache, sleep disturbance, and daytime sleepiness. This study aims to investigate the prevalence of nasal obstruction in Saudi Arabia and examine its effect on patients' quality of life. Methods: This is a cross-sectional study conducted in Saudi Arabia. Data were collected using a self-administered combination of two previously validated questionnaires (the NOSE scale and the WHOQOL-BREF) translated into Arabic. The Mann-Whitney test was used to investigate the association between nasal obstruction prevalence and the participants' QOL. Results: The study included 1039 participants from different regions of Saudi Arabia. The prevalence of nasal obstruction was 60.3% among the participants. Several factors significantly affected the prevalence of nasal obstruction, including sex, suffering from a chronic disease, having a family member with nasal obstruction, and using medications (P < 0.001 for all factors). A better score was shown in the four domains of the WHOQOL-BREF questionnaire by the participants who had no nasal obstruction: the physical health domain, psychological health, social relationships, and environment (P < 0.001 for all factors). Conclusions: Quality of life is affected by nasal obstruction. The subjective assessment is essential in evaluating the severity of nasal obstruction disease. It is recommended that healthcare providers use subjective tools combined with objective tools to assess the degree of nasal obstruction severity.

Indoor sulfur dioxide prediction through air quality modeling and assessment of sulfur dioxide and nitrogen dioxide levels in industrial and non-industrial areas.

In this study, the levels of sulfur dioxide (SO2) and nitrogen dioxide (NO2) were measured indoors and outdoors using passive samplers in Tymar village (20 homes), an industrial area, and Haji Wsu (15 homes), a non-industrial region, in the summer and the winter seasons. In comparison to Haji Wsu village, the results showed that Tymar village had higher and more significant mean SO2 and NO2 concentrations indoors and outdoors throughout both the summer and winter seasons. The mean outdoor concentration of SO2 was the highest in summer, while the mean indoor NO2 concentration was the highest in winter in both areas. The ratio of NO2 indoors to outdoors was larger than one throughout the winter at both sites. Additionally, the performance of machine learning (ML) approaches: multiple linear regression (MLR), artificial neural network (ANN), and random forest (RF) were compared in predicting indoor SO2 concentrations in both the industrial and non-industrial areas. Factor analysis (FA) was conducted on different indoor and outdoor meteorological and air quality parameters, and the resulting factors were employed as inputs to train the models. Cross-validation was applied to ensure reliable and robust model evaluation. RF showed the best predictive ability in the prediction of indoor SO2 for the training set (RMSE = 2.108, MAE = 1.780, and R2 = 0.956) and for the unseen test set (RMSE = 4.469, MAE = 3.728, and R2 = 0.779) values compared to other studied models. As a result, it was observed that the RF model could successfully approach the nonlinear relationship between indoor SO2 and input parameters and provide valuable insights to reduce exposure to this harmful pollutant.

Mesoporous silica nanoparticles: Their potential as drug delivery carriers and nanoscavengers in Alzheimer's and Parkinson's diseases.

Worldwide, populations face significant burdens from neurodegenerative disorders (NDDs), especially Alzheimer's and Parkinson's diseases. Although there are many proposed etiologies for neurodegenerative disorders, including genetic and environmental factors, the exact pathogenesis for these disorders is not fully understood. Most patients with NDDs are given lifelong treatment to improve their quality of life. There are myriad treatments for NDDs; however, these agents are limited by their side effects and difficulty in passing the blood-brain barrier (BBB). Furthermore, the central nervous system (CNS) active pharmaceuticals could offer symptomatic relief for the patient's condition without providing a complete cure or prevention by targeting the disease's cause. Recently, Mesoporous silica nanoparticles (MSNs) have gained interest in treating NDDs since their physicochemical properties and inherent ability to pass BBB make them possible drug carriers for several drugs for NDDs treatment. This paper provides insight into the pathogenesis and treatment of NDDs, along with the recent advances in applying MSNs as fibril scavengers. Moreover, the application of MSNs-based formulations in enhancing or sustaining drug release rate, and brain targeting via their responsive release properties, besides the neurotoxicity of MSNs, have been reviewed.

A theoretical model of college students' sleep quality and health-related quality of life.

Poor sleep confers significant morbidities and is highly prevalent among college students in the United States. This research assessed sleep quality and its association with health-related quality of life (HRQOL). Further, because sleep quality research often lacks a theoretical foundation, we applied a theoretical model using selected constructs from the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). A random, stratified sample of undergraduate students participated in an online survey (N = 494). Structural equation modeling assessed the association between theoretical constructs, sleep quality, and HRQOL. The final model fit was acceptable, with ~ 20% of the variance in sleep quality explained by the theoretical constructs and control variables. HBM constructs were indirectly and negatively related to sleep quality, mediated through behavioral intention, and also positively and directly associated with behavioral intention. Behavioral intention was strongly and negatively associated with sleep quality. Approximately 31% of the variance in HRQOL was explained by poor sleep quality, behavioral intention, and gender. Poor sleep was most strongly associated with reduced HRQOL. HBM constructs and behavioral intention from TPB were significantly associated with poor sleep quality, and poor sleep was significantly related to poor HRQOL.

Beneficial and toxicological aspects of zinc oxide nanoparticles in animals.

Nanotechnology is a far-reaching technology with tremendous applications in various aspects, including general medicine, veterinary medicine, agriculture, aquaculture, and food production. Nanomaterials have exceptional physicochemical characteristics, including increased intestinal absorption, biodistribution, bioavailability, and improved antimicrobial and catalytic properties. Although nanotechnology is gaining ground in animal management, husbandry, and production, its wide use is still hampered by occasional toxicity and side effects. Zinc oxide nanoparticles (ZnO-NPs) have long been utilized in animal production, aquaculture, and pet animal medicine. However, the use ZnO-NPs in animals has been associated with reports of toxicity and side effects. ZnO-NPs may have shown numerous beneficial effects in animals; its use must be regulated with care to avoid unwanted consequences. Thus, this review emphasizes the usage of ZnO-NPs in animal production and laboratory animals and the potential side effects associated with the use of nanoparticles as a feed supplement and therapeutic compound.

A Narrative Review on Current Diagnostic Imaging Tools for Dentomaxillofacial Abnormalities in Children.

The current review narrates the findings and discusses the available diagnostic tools for detecting structural abnormalities. The review discusses several diagnostic tools, such as magnetic resonance imaging, cone beam computed tomography, multi detector row CT and positron emission tomography. The vital findings and comparative analysis of different diagnostic tools are presented in this review. The present review also discusses the advent of newer technologies, such as the HyperionX9 scanner with less field of view and 18F-FDG PET/CT (positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose, integrated with computed tomography), which can give more efficient imaging of dentomaxillofacial structures. The discussion of effective comparative points enables this review to reveal the available diagnostic tools that can be used in the detection of dentomaxillofacial abnormalities in the pediatric population. The advantages and disadvantages of each tool are discussed, and the findings of past publications are also presented. Overall, this review discusses the technical details and provides a comparative analysis of updated diagnostic techniques for dentomaxillofacial diagnosis.

Elucidating the Correlation of D-Dimer Levels with COVID-19 Severity: A Scoping Review.

Aims: The review explores the findings of previous studies to elucidate the association between levels of D-dimer and COVID-19 severity and prognosis. In addition, we assessed the efficiency of anticoagulant therapies in reducing COVID-19 severity and improving the prognosis of the patients. Materials and Methods: A comprehensive literature review was conducted using MEDLINE/PubMed databases, Scopus, and Web of Science with the help of keywords "COVID-19," "D-Dimer," "Thrombosis," "Fibrin network," "Anticoagulant therapy," "Inflammation," and "disease severity." Based on all these articles and clinical experience, a scoping review was constructed and the full texts of the articles that were retrieved were accessed. Results: A D-dimer is a complex protein molecule that is formed during plasmin-mediated degradation of the fibrin network. Thus, it serves as a marker of thrombotic activity. On the other hand, in addition to severe respiratory distress and reduction in pulmonary gas exchange, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also triggers prothrombotic changes in the infected individuals. The levels of D-dimer have been postulated to be positively associated with the degree of disease severity among COVID-19 patients. Conclusions: It has been postulated that D-dimer could potentially be used as a biomarker to predict the prognosis and outcome of COVID-19 patients at the time of admission to hospitals and facilitate more personalized and efficient clinical management that could significantly reduce the mortality rate of such patients and allow more rapid recovery.

Re-Learning EXP3 Multi-Armed Bandit Algorithm for Enhancing the Massive IoT-LoRaWAN Network Performance.

Long-Range Wide Area Network (LoRaWAN) is an open-source protocol for the standard Internet of Things (IoT) Low Power Wide Area Network (LPWAN). This work's focal point is the LoRa Multi-Armed Bandit decentralized decision-making solution. The contribution of this paper is to study the effect of the re-learning EXP3 Multi-Armed Bandit (MAB) algorithm with previous experts' advice on the LoRaWAN network performance. LoRa smart node has a self-managed EXP3 algorithm for choosing and updating the transmission parameters based on its observation. The best parameter choice needs previously associated distribution advice (expert) before updating different choices for confidence. The paper proposes a new approach to study the effects of combined expert distribution for each transmission parameter on the LoRaWAN network performance. The successful transmission of the packet with optimized power consumption is the pivot of this paper. The validation of the simulation result has proven that combined expert distribution improves LoRaWAN network's performance in terms of data throughput and power consumption.

Cross-Sectional Survey among General Population Regarding Knowledge and Attitude toward Antibiotic Usage in Western Saudi Arabia.

BACKGROUND: Antibiotic resistance is a threatening issue to human wellbeing and an obstacle in the treatment process of many life-threating illnesses. This study aims to assess the knowledge and attitudes toward antibiotic usage among the general population in Jeddah, Saudi Arabia. METHODS: A self-administered cross-sectional survey of 460 participants was distributed among the general population in Jeddah in the form of a validated questionnaire. Sample size was calculated to be 460 adults of either gender. Descriptive and inferential statistical analyses were performed using the Statistical Package for Social Sciences. RESULTS: the age of more than half of participants (55.6%) was 18-30 years old, followed by the age group 31-40 years old (26.6%), with the smallest age group >60 years old (1.9%). More than two thirds of participants were male (69.5%), while 131 were female, accounting for 30.5%. Almost one third of participants had poor knowledge about antibiotics (30.5%), 51.0% had used antibiotics without any prescriptions, 54.6% of participants thought antibiotics could be used to treat viral infections, and 55.1% thought it was acceptable to stop taking antibiotics if symptoms start to improve. In addition, 49% believed that taking antibiotics would help them get better more rapidly when suffering from the common cold. Some personal characteristics were significantly associated with the public's knowledge (e.g., age, education, and monthly income) and their attitudes (e.g., monthly income). CONCLUSION: Findings revealed a low level of knowledge on the use of antibiotics among the general public in Jeddah. This study signifies the need for improvement in the public's knowledge and enhancement of their attitudes toward proper utilization of antibiotics.

Electroconvulsive Therapy as a Treatment for Somatization Disorder.

OBJECTIVE: To review the published literature over the last 10 years for the efficacy of electroconvulsive therapy (ECT) in refractory somatization disorder. DATA SOURCES: A comprehensive evidence search of the published literature in the last 10 years (2010-2020) was conducted using the search terms ECT, electroconvulsive therapy, efficacy, effectiveness, use of ECT, chronic pain, somatoform disorders, somatoform pain, somatic symptom disorder, and somatization disorder. The review was limited to articles written in the English language. Databases searched included PsycInfo, MEDLINE, PubMed, Embase, and Google Scholar. A supplementary citation search was also conducted by analyzing the reference lists of identified sources. STUDY SELECTION: The initial search revealed 31 articles of potential relevance. DATA EXTRACTION: The studies were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review. DATA SYNTHESIS: Five single case studies, 1 case series, and 1 open trial focusing on the use of ECT in somatization disorder were identified for inclusion in the review. There were no controlled trials or systematic reviews, and the evidence collated was of low quality. CONCLUSIONS: This review indicates that ECT may be an effective treatment option for severe and refractory manifestations of somatization disorder. However, further research is required in the assessment of the efficacy, safety, and tolerability of ECT in somatization disorder.

Electroconvulsive Therapy in Multiple Sclerosis: A Review of Current Evidence.

OBJECTIVE: To review the published literature over the last 5 years on the use of electroconvulsive therapy (ECT) in multiple sclerosis (MS), focusing on efficacy, safety, and tolerability. MS commonly has neuropsychiatric comorbidity. ECT is used in MS for severe and life-threatening forms of mental illness when other treatment options have failed or when a rapid response is required. DATA SOURCES: English-language literature published in the last 5 years (January 2015-June 2, 2020) was searched using the terms: ECT, electroconvulsive therapy, shock therapy, electroshock therapy, electroconvulsive therapies, multiple sclerosis, chronic progressive multiple sclerosis, acute relapsing multiple sclerosis, and multiple sclerosis, relapsing and remitting. KnowledgeShare, a National Health Service library application providing updates on evidence-based practice, was used along with EMBASE, PsycInfo, MEDLINE, PubMed, the TRIP database (which offers a complete and updated list of evidence-based online resources), HDAS (Healthcare Databases Advanced Search), CRDWeb (Centre for Reviews and Dissemination), and the Cochrane Library. Reference lists of articles identified in the search were also reviewed. STUDY SELECTION: Our initial search revealed 30 articles of potential relevance. However, after individually evaluating these articles, only 6 case studies and 1 review article detailing the use of ECT in MS were included. DATA EXTRACTION: The studies were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review. DATA SYNTHESIS: The efficacy and safety in using ECT for MS is derived only from case series and case reports. There were no controlled trials or systematic reviews, and the evidence collated was of low quality. CONCLUSIONS: The consensus is that ECT is an effective treatment for specific mental disorders in MS including catatonia. We have used ECT successfully in our clinic for patients with MS. However, there are concerns about the potential effects of ECT on neurologic and cognitive function. There are also possible risks with using anesthetic agents and particularly neuromuscular blockers.

Electroconvulsive Therapy as a Treatment for Tardive Dyskinesia.

OBJECTIVE: To review the published literature over the last 10 years for the use of electroconvulsive therapy (ECT) in tardive dyskinesia (TD), focusing on the efficacy of this treatment. DATA SOURCES: A comprehensive evidence search of the published literature in the last 10 years (2010-2020) was conducted using the search terms electroconvulsive therapy, electroshock therapy, ECT, tardive dyskinesia, and tardive dystonia. The review was limited to articles published in the English language. MEDLINE, Embase, PubMed, PsycInfo, Cochrane Library, Google Scholar, and the NICE (National Institute for Health and Care Excellence) guidelines were also searched. STUDY SELECTION: Twenty-three case studies published within the last 10 years were retrieved. The search revealed 5 articles of potential relevance. DATA EXTRACTION: The articles were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review. DATA SYNTHESIS: The efficacy in using ECT for TD is derived only from case series and case reports. There were no controlled trials, and the evidence collated was limited and of low quality. CONCLUSIONS: The review indicates that ECT could be considered as a treatment for TD. However, this treatment may only be considered when patients present with a coexistent refractory mood or affective disorder. Further clinical trials are needed to improve understanding regarding the efficacy, tolerability, and safety of using ECT in this patient group.

Molecular Detection of Staphylococcal Enterotoxins and mecA Genes Products in Selected Food Samples Collected from Different Areas in Khartoum State.

Staphylococcal food poisoning is an intoxication that results from the consumption of improperly prepared or stored foods containing sufficient amounts of one or more preformed S. aureus enterotoxins. Nowadays, many researchers worldwide noted an emergence of resistant strains such as Staphylococci particularly for the antibiotic methicillin. Therefore, this study was aimed to determine the existence of Staphylococcus aureus and its enterotoxins, mecA genes, in selected food samples. A total of 400 selected food samples were collected from different areas in Khartoum State. The selected foods included cheese, meat products, fish, and raw milk. One hundred samples from each type of food were cultivated, and the resultant growth yielded 137 (34.25%) S. aureus, 126 (31.5%) bacteria other than S. aureus, and 137 (34.25%) yielded no growth. Eighty-four of the 137 S. aureus isolates were randomly selected and tested for the presence of mecA and enterotoxin genes. The oxacillin sensitivity test showed that 15 (11%) of 137 S. aureus isolates were oxacillin resistant. The PCR assay showed that the mecA gene was detected in 15 of 84 (17%) S. aureus isolates. Simultaneously, only 2 (2.385%) out of 84 S. aureus isolates showed an enterotoxin B gene product. There was a relatively moderate prevalence of methicillin-resistant Staphylococcus aureus with very low frequency of enterotoxin B gene in different kinds of selected food samples collected from Khartoum State. These findings elucidate the increased risk on public in Khartoum being affected by Staphylococcal food poisoning upon consumption of dairy or meat products prepared in unhygienic conditions that could lead to intoxication by Staphylococcus aureus enterotoxins.

Early Diagnosis and Management of Bulimia Nervosa in Type 1 Diabetes.

Treatment outcomes for bulimia nervosa in type 1 diabetes are worse than those for conventional bulimia nervosa. These outcomes may be a consequence of late detection and subsequent management. The combination of these disorders has been referred to as diabulimia; however, this is not an official diagnosis and is a colloquial term used by patients and the media to describe the associated maladaptive pattern of compensatory behaviors. Early intervention is required to prevent short- and longer-term complications, with intensive treatment approaches having the best current evidence. Collaboration is required between specialist services for patients to receive optimal care. This narrative review summarizes the latest published evidence in the formulation, detection, and subsequent management of bulimia nervosa in type 1 diabetes, while highlighting the need for higher-quality research in the assessment and treatment of these comorbidities.

Psychiatric Disorder in Postural Orthostatic Tachycardia Syndrome and Ehlers-Danlos Syndrome-Hypermobility Type.

Postural orthostatic tachycardia syndrome (POTS) and Ehlers-Danlos syndrome-hypermobility type (EDS-HT) are disorders that have a strong association and share a relationship with some mental illnesses. Both are commonly misdiagnosed as mental disorders possibly because they share a similar phenomenology to some. There is limited awareness and recognition of POTS and EDS-HT, which subsequently delays diagnosis. The presence of an underlying mental disorder can complicate the diagnosis and management of an already challenging case, which can cause further strain to patients and their loved ones whose lives have already been destabilized significantly. National support groups have been established to support during the stressful periods of diagnosis and adjustment. In this article, the evidence for the various mental disorders that have been linked to POTS and EDS-HT is reviewed, while highlighting the need to satisfactorily screen for mental disorders in this patient group.​.