Prevalence and epidemiological trends in mortality due to COVID-19 in Saudi Arabia.

OBJECTIVES: This article describes the prevalence and epidemiological trends of COVID-19 mortality in the largest registry in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN: A prospective epidemiological cohort study using data from all healthcare facilities in KSA collected between March 23, 2020, and April 30, 2022. Data on the number of daily deaths directly related to COVID-19 were gathered, analyzed, and reported. METHOD: Data analysis was carried out using national and regional crude case fatality rate and death per 100,000 population. Descriptive statistics using numbers and proportions were used to describe age, gender, nationality, and comorbidities. The mortality trend was plotted and compared with international figures. In addition, the most common comorbidities associated with mortality and the proportion of patients who received COVID-19 vaccine were reported. RESULTS: The total reported number of deaths between March 23, 2020, and April 30, 2022, was 9085. Crude case fatality rate was 1.21%, and death per 100,000 population was 25.38, which compared favorably to figures reported by several developed countries. The highest percentages of deaths were among individuals aged between 60 and 69 years, males (71%), and individuals with diabetes (60%). Only 2.8% of mortalities occur in patients who received COVID-19 vaccine. Diabetes, hypertension, and heart failure had the highest attributable risk of mortality among patients who died due to COVID-19. CONCLUSION: Case fatality rate and death per 100,000 population in KSA are among the lowest in the world due to multiple factors. Several comorbidities have been identified, namely, diabetes, hypertension, obesity, and cardiac arrhythmias.

Healthcare providers' satisfaction with participation in private health insurance scheme in a city in the southern Nigeria

Health insurance coverage in Nigeria is still very low as over 70% of health care expenditure is financed by out-of-pocket payment. Health care providers are critical participants in the private health insurance scheme, therefore, their perception and satisfaction with the scheme is fundamental in ensuring sustainability. This study assessed health providers' satisfaction with private health insurance scheme in Port Harcourt Rivers State.Method: A descriptive cross-sectional study which engaged a two-stage sampling method to recruit 60 participating health facilities and 180 responding health personnel by simple random sampling at each stage. A structured, pretested interviewer-administered questionnaire was used to collect data on the levels of satisfaction with the four major domains of satisfaction viz; billing rate, payment models, HMO administrative processes and claims management. Data was analysedusing of SPSS, version 26. Characteristics of the responding facilities were tabulated and compared. Level of satisfaction was deduced by Likert Scale according to the domains of satisfaction. Regression analysis with p-value was set at less than or equal to 0.05 was used to determine the predictors of satisfaction with participation in health insurance. The level of satisfaction with negotiated billing rates, payment models, HMO administrative processes and claims management were analyseddescriptively, and results were presented as means, standard deviation, frequencies and percentages, in tables, pie and bar charts

Do We Need Gadolinium-Based Contrast Agents for Routine MRI Surveillance of Unoperated Pituitary Macroadenoma?

BACKGROUND AND PURPOSE: The use of gadolinium-based contrast agents contributes to the cost of MR imaging and prolongs image-acquisition time. There are also recent concerns regarding gadolinium deposition, particularly in patients who require frequent follow-up MRIs. The purpose of this study was to assess whether gadolinium-based contrast agents are needed during MR imaging follow-up for unoperated pituitary macroadenoma. MATERIALS AND METHODS: A total of 105 patients with unoperated pituitary macroadenoma who underwent follow-up MR imaging of the sella were included in this retrospective study. The craniocaudal dimension, cavernous sinus invasion grading, and optic pathway compression were assessed independently on coronal T2WI and compared with coronal T1-weighted images with gadolinium-based contrast agents (T1 postcontrast images). The agreement between the T2WI and T1 postcontrast images for the craniocaudal dimension was assessed using the intraclass correlation coefficient; for the cavernous sinus invasion and optic pathway compression, it was assessed using κ statistics. RESULTS: There was excellent agreement for the craniocaudal dimensions between T2WI and T1 postcontrast images (intraclass correlation coefficient = 0.96, P < .001; 95% CI, 0.84-0.99). Additionally, there was almost-perfect agreement between cavernous sinus invasion and optic pathway compression between T2WI and T1 postcontrast images, with κ = 0.95 and 0.84, respectively (P < .001). CONCLUSIONS: MR imaging of the sella without the use of gadolinium-based contrast agents could potentially be considered for the follow-up of unoperated pituitary macroadenomas. This choice can reduce the MR imaging examination cost and acquisition time and avoids potential adverse effects of gadolinium-based contrast agents.

OSAS and upper pharynx surgery: Does basilingual collapsus always rhyme with failure?

OBJECTIVE: Drug-induced-sedation endoscopy (DISE) has proved superior to awake clinical examination for diagnosis of upper-airway obstruction sites and surgical planning. Our question is: does multilevel obstruction on DISE systematically entail failure for surgery limited to the upper pharynx? MATERIAL & METHODS: We conducted a retrospective single-center study in patients with obstructive sleep apnea syndrome (OSAS) treated by single-level surgery of the upper pharynx (tonsillectomy with or without pharyngoplasty). Preoperative assessment included polysomnography (PSG) and DISE. Surgical efficacy was assessed on postoperative PSG. Treatment response was defined by postoperative apnea-hypopnea index (AHI) <20 events/h with 50% reduction, and cure by AHI <10 (patients with preoperative AHI ≤10 being excluded). Efficacy was compared between groups without (group A) and with basilingual or laryngeal collapsus on DISE (group B). RESULTS: We analyzed 63 patients, with mean preoperative AHI 33.8±17.9 events/h. The two groups (A, n=36; B, n=27) were clinically comparable. Postoperative PSG took place at a mean 8.5 ± 11.5 months. The success rate was 66.7% in group A (mean reduction in AHI, 57.3±36.2%) and 59.3% in group B (mean reduction, 53.9±39.2%). Cure rates were respectively 48.5% and 48.1%. There was no statistically significant difference between the two groups (P>0.1). CONCLUSIONS: Oropharyngeal surgery can alleviate associated obstructive sites found on DISE in the lower pharynx, and step-by-step treatment shows efficacy equal to that of single-step multilevel surgery.

The toll of noninfected CRS patients to the COVID-19 pandemic.

Social distancing with the aim of avoiding infections and pre-serve critical care capacities during the COVID-19 pandemic has been implemented in Germany according to World Health Organization (WHO) recommendations from early March onwards. Limitations of physical contacts to reduce exposure to SARS-CoV-2 infected individuals were handled strictly, particularly in medical centers dealing with airway diseases, like rhinology and pneumology clinics. Such measures and reluctance to visit out- and inpatient services resulted in a 82% decrease in consultations to the 12 German oto-rhino-laryngological (ORL) centres forming our database during the 50 days following March 09 in 2020 if compared to the same period in 2019. Our data on CRS care underline reports on undertreatment of non-COVID-19 individuals with several different diseases during the current pandemic. We should try to reduce the toll these patients have to pay as much as possible. We established telemedicine, e-Health and artificial intelligence-supported triage for selecting the right patients for onsite-consultations and to advise patients in several demands.

Experience With Ceftolozane-Tazobactam for the Treatment of Serious Pseudomonas aeruginosa Infections in Saudi Tertiary Care Center.

INTRODUCTION: Multidrug-resistant Pseudomonas aeruginosa isolates have multiple resistance mechanisms, and there are insufficient therapeutic options to target them. Ceftolozane-tazobactam is a novel antipseudomonal agent that contains a combination of an oxyimino-aminothiazolyl cephalosporin (ceftolozane) and a ß-lactamase inhibitor (tazobactam). METHODS: A single-center retrospective observational study between January 2017 and December 2018 for patients who had been diagnosed with carbapenem-resistant P aeruginosa infections and treated with ceftolozane-tazobactam for more than 72 hours. We assessed clinical success based on microbiological clearance as well as the clinical resolution of signs and symptoms of infection. RESULTS: A total of 19 patients fit the inclusion criteria, with a median age was 57 years, and 53% were female. The types of infections were nosocomial pneumonia, acute bacterial skin, and skin structure infections; complicated intra-abdominal infections; and central line-associated bloodstream infections. All of the isolates were resistant to both meropenem and imipenem. The duration of therapy was variable (average of 14 days). At day 14 of starting ceftolozane-tazobactam, 18 of 19 patients had a resolution of signs and symptoms of the infection. Only 14 of 19 patients (74%) had proven microbiological eradication observed at the end of therapy. During therapy, there was no adverse event secondary to ceftolozane-tazobactam, and no Clostridium difficile infection was identified. The 30-day mortality rate was 21% (4/19). CONCLUSIONS: Multidrug-resistant P aeruginosa infection is associated with high mortality, which would potentially be improved using a new antibiotic such as ceftolozane-tazobactam. Studies are required to explain the role of combination therapy, define adequate dosing, and identify the proper duration of treatment.

CYFRA 21-1 and MMP-9 as salivary biomarkers for the detection of oral squamous cell carcinoma: a systematic review of diagnostic test accuracy.

Tissue biopsy with histopathological examination is still considered the gold standard to diagnose oral squamous cell carcinoma (OSCC). This systematic review explored the diagnostic test accuracy of two salivary biomarkers in adults suspected of OSCC. The Cochrane Library, MEDLINE, and Embase databases were searched for clinical studies evaluating the diagnostic accuracy of salivary biomarkers in detecting OSCC. Studies were eligible for inclusion if only singular salivary biomarkers were evaluated in three or more studies. Studies investigating combined salivary biomarkers or assessing patients with oral potentially malignant disorders only were excluded. The reporting of the review follows the PRISMA checklist. Six studies, recruiting 775 participants, were included in this review for only two salivary biomarkers, cytokeratin 19 fragment (CYFRA 21-1) and matrix metalloproteinase 9 (MMP-9). The sensitivity and specificity (with 95% confidence intervals) for CYFRA 21-1 studies ranged from 0.84 (0.75-0.91) to 0.94 (0.83-0.99) and from 0.84 (0.71-0.93) to 0.96 (0.80-1.00), respectively. In MMP-9 studies, sensitivity (with 95% confidence intervals) ranged from 0.76 (0.67-0.83) to 1.00 (0.78-1.00) and specificity from 0.27 (0.12-0.46) to 1.00 (0.78-1.00). The overall quality of the included studies was poor. Due to a lack of strong and high-quality evidence, considerable uncertainty remains surrounding the use of singular salivary biomarkers for the detection of OSCC.

Surgical ablation of lingual tonsils in the treatment of obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: The retrolingual space is one of the potential sites of obstruction identified in patients with obstructive sleep apnea syndrome (OSAS). Hypertrophied lingual tonsils (LT) can obstruct the airway at this level. The goal of this study was to measure the tolerance and efficacy of lingual tonsillectomy in patients with OSAS. STUDY DESIGN: A retrospective chart review was conducted recruiting all patients with OSAS confirmed on sleep recording, who either had failed or refused medical treatment and who underwent lingual tonsillectomy. MATERIALS AND METHODS: Diagnosis of LT hypertrophy was made by full ENT clinical examination using a flexible endoscopy, completed by MRI and followed by drug-induced sleep endoscopy. The surgical intervention was carried out endoscopically by diode laser or coblation. The primary endpoint to measure efficacy was drop in apnea-hypopnea index (AHI) on sleep recording at 6 months. Secondary endpoints comprised reduced snoring and Epworth Sleepiness Scale (ESS) and postoperative symptom tolerance. RESULTS: Eleven patients aged 44.3±12.6 years were included. AHI dropped from 29.5±21.7/h to 11.6±9.6/h: i.e., by 60% (P=0.005). Five patients had AHI<10/h: i.e., cure rate of 45%. ESS dropped from 13±3.4 to 8.1±4.9 (P=0.012). No complications were observed. CONCLUSIONS: LT ablation seemed effective in OSAS with retrolingual obstruction in failure of medical treatment. LEVEL OF EVIDENCE: 4.

Frictional coefficient during flossing of teeth.

OBJECTIVE: This in-vitro study aimed to develop a technique to measure the frictional forces and determine the frictional coefficient (µ) associated with the rubbing of dental floss against teeth. Incorrect flossing technique and the etiology of grooves at the cementoenamel junction (CEJ) of proximal area of teeth has long been a controversial topic. We hypothesized that the µ between teeth surfaces and dental floss is affected by contact angulation. MATERIALS AND METHODS: Tests were conducted using two different types of dental floss (waxed and unwaxed nylon) on different surfaces (enamel, dentine, smooth and rough glass rods) under different moisture conditions (dry and wet). The µ generated by performing C-shape flossing was measured, using the Capstan equation, at constant load (100g) over different flossing contact sliding angulations. In addition, the surface characteristics of intact and used nylon flosses were compared using a scanning electron microscope (SEM). RESULTS: The mean µ was highest with a smooth glass rod (0.42±0.11), followed by rough glass rods (0.30±0.07), dry enamel (0.27±0.08), wet enamel (0.23±0.06), then dentine (0.18±0.04). Moreover, higher µ was associated with waxed floss when used against dry enamel, smooth and rough glass rods (P<0.001). At different moisture conditions, waxed floss demonstrated greater µ with dry surfaces (P<0.03). No association was found between µ and dental floss contact angulation. Both floss types showed deterioration after usage; although waxed type exhibited markedly greater deterioration when used on dry surfaces. In conclusion, the magnitude of the µ was found to be influenced by surface roughness, moisture condition, and independent of the contact angulation area during sliding of dental floss. SIGNIFICANCE: It is important to consider the potential side effects of frictional forces on both tooth surface and dental floss during clinical application.

Specific retinal phenotype in early IQCB1-related disease.

PurposeTo describe the ocular and systemic phenotype in IQCB1-related disease.MethodsFour cases (3 males, 1 female) with molecularly confirmed IQCB1-related disease underwent ophthalmological examination including best-corrected visual acuity (BCVA) measurement, fundus evaluation, electroretinography (ERG), and spectral-domain optical coherence tomography (SD-OCT). Systemic evaluation including abdominal ultrasound was performed in all cases.ResultsBCVA ranged from perception of light (Case-2; 1 year) to 20/125 (Case-1; 9 years). Fundus evaluation showed whitish or silvery reflex outside the vascular arcades in all cases; the reflex was circumferential, irregular and covered at-least 6 clock hours at younger ages (3 cases; 1-4 years). The reflex was less conspicuous with increasing age (Case-1 (9 years) and Case-4 (20 years)). The peripheral retinal SD-OCT scans showed evidence of extensive deposition at the level of retinal pigment epithelium with complete absence of overlying photoreceptor outer segments and myoid zone. The ERG was non-detectable in all cases. All cases harbored biallelic nonsense (p.R364*, p. R455*) or frameshifting (p.M370Yfs*49, p.C253Afs*9) mutations in IQCB1. Case-1 additionally had developmental delay, hemi-hyperplasia, toe syndactyly, and kidney cysts.ConclusionIQCB1-related syndromic or non-syndromic Leber congenital amaurosis (LCA) carries unique retinal characteristics which helps differentiate IQCB1-retinopathy from other genetic forms of LCA in childhood.

Radiation hazards and lifetime risk assessment of tap water using liquid scintillation counting and high-resolution gamma spectrometry.

In this work, two complementary techniques, viz. liquid scintillation counting and high-resolution gamma spectrometry are utilized to analyze radionuclides concentrations in tap water of Irbid governorate, Jordan, and study their correlation. Gross alpha and gross beta concentrations, in the tap water samples collected from the nine districts of Irbid governorate, ranged from <82 to 484 mBq/L with a mean of 295 mBq/L and from <216 to 984 mBq/L with a mean of 611 mBq/L, respectively. Furthermore, gamma spectrometry analysis, for the tap water samples, shows that the activity concentrations of 226Ra, 232Th, and 40K ranged between <19 and 302 mBq/L, 24 to 119 mBq/L, and <101 to 342 mBq/L, respectively. There was a weak or even no correlation among the identified natural radionuclides with no trace of artificial radioactivity. In addition, the results of both techniques show that storing tap water in drilled wells leads to higher levels of radioactivity concentrations beyond the international permissible limits. Furthermore, the average lifetime risk and annual effective dose received by age-grouped inhabitants due to direct and indirect tap water consumption are evaluated, where most of the received dose is attributed to 226Ra.

Reduced NFAT1 protein expression in human umbilical cord blood T lymphocytes.

Umbilical cord blood (UCB) stem cells from related and unrelated allogeneic donors have emerged as novel treatment for patients with hematologic malignancies. The incidence and severity of acute graft-versus-host disease (GVHD) after UCB transplantation compares favorably with that observed in recipients of matched unrelated donor allogeneic grafts, but remains a major cause of morbidity and mortality. It has been shown that stimulated lymphocytes from UCB have reduced production of cytokines including interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha), which play a role in GVHD pathophysiology. We investigated the molecular mechanisms underlying this reduced cytokine production by analyzing expression of nuclear factor of activated T cells-1 (NFAT1) in UCB T cells. We detected no constitutive expression of NFAT1 protein in unstimulated UCB T cells compared with adult T cells. Moreover, although NFAT1 expression in UCB T cells was upregulated after prolonged (40 hours) T-cell stimulation, it was only partially upregulated when compared with adult controls. Our observation of minimal NFAT1 expression after stimulation correlated with reduced cytoplasmic IFN-gamma and TNF-alpha production in UCB T cells studied simultaneously. Reduced NFAT1 expression may blunt amplification of donor UCB T-cell alloresponsiveness against recipient antigens, thereby potentially limiting GVHD incidence and severity after allogeneic UCB transplantation.

Personification of death in Ghanaian death notices.

Analysis of content of death notices (obituaries, in memoriams, and funeral announcements) may offer some explanation of how Ghanaians express their feelings about the death of loved ones and the meanings they assign to death and dying. Analysis of 371 death notices selected from two widely read Ghanaian newspapers, the Daily Graphic and the Ghanaian Times yielded six thematic expressions about death and dying: death is personified as cold and unfeeling and described as an ongoing painful experience: the deceased is described as beloved, devoted, and valued. Death notices indicate impending restructured roles and social relationships survivors face; the image and personality of the deceased are included; and the availability and proximity of the deceased's next of kin can be inferred. The findings add to the literature on (1) cultural attitudes toward death and (2) how death is managed and feelings about death and dying are expressed.

Regulation of bFGF expression and ANG II secretion in cardiac myocytes and microvascular endothelial cells.

Basic fibroblast growth factor (bFGF; fibroblast growth factor-2) and angiotensin II (ANG II), among other peptide signaling autacoids (cytokines), are known to regulate the phenotypic adaptation of cardiac muscle to physiological stress. The cell type(s) in cardiac muscle responsible for ANG II synthesis and secretion and the role of endogenous cytokines in the regulation of bFGF induction remain unclear. With the use of confluent, serum-starved, low-passage cultures of cardiac microvascular endothelial cells (CMEC), ANG II could be detected in cellular lysates and in medium conditioned by these cells with the use of high-performance liquid chromatography followed by radioimmunoassay. The secretion of angiotensins by individual CMEC could be detected with a cell-blot assay technique. ANG II secretion was decreased by brefeldin A, an agent that interrupts constitutive and regulated secretory pathways for peptide autacoid/ hormone synthesis, suggesting de novo synthesis, activation, and secretion of angiotensins by CMEC. In primary isolates of adult rat ventricular myocytes (ARVM) and CMEC, ANG II, acting at ANG II type 1 receptors in both cell types, was found to increase bFGF mRNA levels measured by ribonuclease protection assay. Endothelin-1 (ET-1), which is known to be synthesized by CMEC, and bFGF itself, which has been detected in both ARVM and CMEC, increased bFGF transcript levels in both cell types. Interleukin-1beta (IL-1beta), which like ANG II and ET-1 is known to activate mitogen-activated protein kinases in both ARVM and CMEC, increased bFGF mRNA levels only in cardiac myocytes. Thus cytokines such as ANG II, ET-1, bFGF, and IL-1beta locally generated by cellular constituents of cardiac muscle, including CMEC, regulate bFGF mRNA levels in a cell type-specific manner.

Echinococcosis of the heart: clinical and echocardiographic features in 19 patients.

We describe clinical and echocardiographic features in 19 patients with cardiac echinococcosis. Wide variability in the location and number of cysts inside cardiac cavities, septum, and pericardium is observed. The central role of two-dimensional echocardiography in making the diagnosis is stressed. This report has a significant clinical value in view of the large number of cases of a relatively rare condition.

Regulation of heparin-binding epidermal growth factor-like growth factor mRNA levels by hypertrophic stimuli in neonatal and adult rat cardiac myocytes.

Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a recently characterized member of the EGF family of peptide signaling factors that acts as an early response gene to growth stimuli in vascular smooth muscle cells, as well as being a potent mitogen for these cells. As many of these growth stimuli also induce a hypertrophic response in heart muscle, we examined the regulation of HB-EGF mRNA abundance and function in primary cultures of neonatal rat ventricular myocytes and adult rat ventricular myocytes (ARVM). HB-EGF mRNA levels increased 40- and 6-fold in neonatal rat ventricular myocytes and ARVM, respectively, following a 2-4-h exposure to the alpha-adrenergic agonist phenylephrine, a known hypertrophic stimulus for these cells. Phenylephrine had no effect on HB-EGF mRNA stability, and induction of HB-EGF could be blocked completely by actinomycin D. HB-EGF mRNA abundance was also increased 15-fold in ARVM maintained in defined medium that had been induced to contract at 3 Hz by continual uniform electric field stimulation, a mechanical stimulus that we have shown preserves contractile function and induces cell growth in vitro. To determine whether cardiac myocytes would respond to exogenous HB-EGF, quiescent ARVM were exposed to defined medium conditioned by transfected COS MT cells overexpressing HB-EGF. These myocytes exhibited nearly a 2-fold increase in protein content at 24 h compared with unstimulated control ARVM exposed to medium conditioned by COS cells transfected with the plasmid vector alone. Thus, neonatal and adult cardiac muscle cells respond to both neurohumoral and mechanical growth stimuli with a marked increase in HB-EGF mRNA, which may act as an early response gene to facilitate hypertrophic growth in these cells.

Management of death and grief in obituary and in memoriam pages of Nigerian newspapers.

This analysis of obituaries and in memoriam advertisements in Nigerian newspapers provides the identification of dimensions of content used to manage death and grief. Ten dimensions of content were abstracted: pictorial representation is a widespread practice, immediacy of announcement following death is an appropriate etiquette in the management of death, funeral arrangements are included as open invitation to a community of mourners, advertisements indicate direct contact and communication with the deceased, contents suggest the belief in personal immortality of the soul, religion is a pervasive and dominating force in advertisements, there are similarities in choice of words used in death advertisements, there is recognition of the temporal nature of life, mourning seems to be an ongoing process, and often the deceased is perceived as resting in peace. Never do obituaries and in memoriam statements include the flaws of the deceased. Clearly, the dimensions of content in the obituaries and in memoriam advertisements of Nigerian newspapers are a specific cultural behavior of people who exhibit similarity in the management of death and grief. These advertisements serve as an unbroken link between the deceased and the bereaved. This study also suggests that openness to death is the appropriate etiquette in the management of death and grief in Nigeria.

[Synthesis of alpha-chrysanthemylmethyl-gamma- and delta-lactones with cytostatic activity]. / Synthese von alpha-Chrysanthemylmethylen-gamma- und delta-Lactonen mit zytostatischer Wirkung.

The synthesis of the alpha-chrysanthemylmethylen-gamma- and delta-lactones 7-9, 11, 12 from the lactones 1-3, 5 and that of 10 from 2-oxo-chroman (4) and the aldehyd 6 is described. The compounds 7-9 and 11, 12 show cytostatic activity.