Evaluation of Retentive Strength of 50 Endodontically-Treated Single-Rooted Mandibular Second Premolars Restored with Cast Post Cores Using 5 Common Luting (Cement) Agents.

BACKGROUND A luting agent is a dental cement used to secure a dental restoration. This study aimed to evaluate retentive strength of 50 endodontically-treated single-rooted mandibular second premolars (extracted) restored using 5 common luting (cement) agents. MATERIAL AND METHODS Fifty single-rooted mandibular second premolars with adequate root length and uniform size/shape were decoronated. After completing endodontic biomechanical preparation and obturation, root canals of all specimens were prepared to receive a cast post core. Depending upon cementation type, CPC specimens were divided in 5 groups (10 each) (Gp): Zinc phosphate (Gp ZP), polycarboxylate (Gp PC), glass ionomer (Gp GI), resin-modified glass ionomer (Gp RGI), and resin cement (Gp RC). Retentive strength was determined using the adhesive failure pull-out test. Mean/standard deviations were calculated for tensile forces (in kilograms) and differences were determined using analysis of variance (ANOVA). Multiple comparison was performed using the t test. A P value of ≤0.05 indicated a statistically significant difference. RESULTS The order of mean tensile strength from higher to lower was Gp RC (21.46) >Gp RGI (18.17) >Gp GI (16.07) >Gp ZP (15.33) >Gp PC (13.63). Differences in retentive strengths between the cements were significant (P≤0.05). Multiple-group comparisons showed that except for Gp ZP and Gp GI, all groups differed significantly from each other. CONCLUSIONS All investigated cements provided optimal retentive strengths, with wide differences between them. Resin cements should be used when CPC removal is not anticipated, while polycarboxylate or zinc phosphate should be used if CPC removal is anticipated.

Prevalence and Variation of Medical Comorbidities in Oral Surgery Patients: A Retrospective Study at Jazan University.

BACKGROUND An aged population is susceptible to chronic diseases, which impacts oral surgery treatment procedures. This retrospective study aimed to evaluate the incidence of medical comorbidities in 640 oral surgery patients treated at the College of Dentistry, Jazan University. MATERIAL AND METHODS This single-center observational study investigated medical records of outpatients who visited Jazan University Dental College Hospital in a 1-year period (2018-2019). Patients’ clinical and radiographic archives were screened to obtain relevant data. Categorical and continuous variables were expressed in terms of frequency and mean values, respectively. Differences in variables were statistically analyzed using the chi-square goodness of fit and proportional test, with a probability value P≤0.05 considered significant. RESULTS Analysis of 640 patient records included records of 300 men and 340 women who underwent oral surgery, of whom 176 patients (27.5%), including 97 men and 79 women, had medical comorbidities. The most common comorbidities were endocrine disease (7.03%), cardiovascular disease (6.71%), respiratory disease (4.53%), and hematological disorders (3.43%). Individual diseases that showed higher prevalence were diabetes mellitus (4.68%), hypertension (3.43%), bronchial asthma (2.65%), and anemia (1.4%). Differences by sex were observed in many individual disorders. CONCLUSIONS Outpatients in oral surgery clinics presented a significant variance in the incidence of medical comorbidities, among which diabetes and hypertension were most common. A proper case history is the best preventive measure that helps a surgeon avert medical emergencies and post-surgical complications.

Prosthodontic Rehabilitation's Role in Alleviating Anxiety and Depression in Mucormycosis-Induced Maxillectomy Patients Post-COVID-19.

BACKGROUND The aim of this study was to assess the influence of maxillofacial prosthodontic rehabilitation on anxiety/depression severity in patients with rhino-orbital cerebral mucormycosis (ROCM) after maxillectomy. MATERIAL AND METHODS Sixty post-mucormycotic patients treated with maxillectomy (33 males, 27 females) were divided into 5 groups based on maxillectomy types (unilateral/bilateral, subtotal/total) and treatment given (psychotherapy/obturator/implant/orbital/ocular prosthesis). Anxiety and depression symptoms were assessed using appearance anxiety inventory (AAI) and patient health questionnaire (PHQ9). Data were collected at 4 time intervals [T0 (before prosthesis), T1 (2 weeks after prosthesis), T2 (6 months) and T3 (1 year). Frequency distribution and mean values were determined for individual group/subgroups/total cohort. Differences between groups were determined using one-way ANOVA (single-factor/Friedman's) followed by post hoc correction (Bonferroni) and t test for unequal variance with probability P value being statistically significant at <0.05. RESULTS The mean scores for appearance anxiety were 29.13±4.72 (diagnostic for existing body dysmorphic disorder) at T0, which decreased to 16.88±3.02 at T3 for the total cohort. The differences for the gender-based cohort, its various groups, and respective subgroups were significant (P<0.05) at various time intervals. The mean scores in the total cohort for depression symptom severity were 16.81±4.89 (moderately severe) at T0, which increased to 18.5±4.94 at T1, followed by reduction at T2 (12.0±4.43; moderate) and T3 (7.38±3.37; mild). Gender differences for both variables were found to be statistically significant (P<0.05). CONCLUSIONS Comprehensive rehabilitation that included a diagnosis of psychological symptoms followed by psychotherapeutic/pharmacotherapeutic/prosthodontic intervention reduced the anxiety/depression symptom levels to normal at 1 year.

Therapeutic Approach for Trigeminal Neuralgia: A Systematic Review.

This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying previously published reviews. An online search was conducted using PubMed, CRD, EBSCO, Web of Science, Scopus, and the Cochrane Library with no limits on publication date or patients' gender, age, and ethnicity. Reviews and meta-analyses of randomized controlled trials pertaining to drug therapy for TN, and other relevant review articles added from their reference lists, were evaluated. Rapid reviews, reviews published in languages other than English, and reviews of laboratory studies, case reports, and series were excluded. A total of 588 articles were initially collected; 127 full-text articles were evaluated after removing the duplicates and screening the titles and abstracts, and 11 articles were finally included in this study. Except for carbamazepine, most of the drugs had been inadequately studied. Carbamazepine and oxcarbazepine continue to be the first choice for medication for classical TN. Lamotrigine and baclofen can be regarded as second-line drugs to treat patients not responding to first-line medication or for patients having intolerable side effects from carbamazepine. Drug combinations using carbamazepine, baclofen, gabapentin, ropivacaine, tizanidine, and pimozide can yield satisfactory results and improve the tolerance to the treatment. Intravenous lidocaine can be used to treat acute exaggerations and botulinum toxin-A can be used in refractory cases. Proparacaine, dextromethorphan, and tocainide were reported to be inappropriate for treating TN. Anticonvulsants are successful in managing trigeminal neuralgia; nevertheless, there have been few studies with high levels of proof, making it challenging to compare or even combine their results in a statistically useful way. New research on other drugs, combination therapies, and newer formulations, such as vixotrigine, is awaited. There is conclusive evidence for the efficacy of pharmacological drugs in the treatment of TN.

A Clinical Study of 50 Partially Edentulous Patients with Fixed Partial Denture Restorations to Compare Clinical Parameters and Changes in Gingival Sulcus Width After Displacement with 2 Different Gingival Retraction Cord Materials (Cotton and Polymer).

BACKGROUND The present study aimed to compare the clinical performance and gingival sulcus width changes in partially edentulous patients using cotton and polymer gingival retraction cords. MATERIAL AND METHODS Fifty partially edentulous patients were divided into 2 groups (Gp C and Gp P) and were subjected to single crown/fixed partial denture treatment. Clinical parameters, including plaque index scores, placement time, and hemorrhage control scores, were assessed. Gingival sulcus width changes before and after retraction were evaluated using individual type 4 dental stone dies observed under an optical microscope. Statistical analysis was performed using dependent/independent t tests. RESULTS The mean placement time, hemorrhage control time, and hemorrhagic scores were lower in Gp P than in Gp C, indicating better clinical performance of polymer-based retraction cord. Both groups showed an increase in sulcus width after retraction, but Gp P had a significantly higher sulcus width (690.03±45.37) compared to Gp C (471.38±28.13). The mean difference in sulcus width between baseline and after retraction was also significantly higher in Gp P (525.84 micrometers) than in Gp C (309.11 micrometers). CONCLUSIONS The present study shows that polymer-based cords produce more sulcus width and have better clinical performance compared to cotton-based gingival retraction cords. These results suggest that the use of polymer-based retraction cords can improve the quality of dental impressions in partially edentulous patients.

Association of early mobility with the incidence of deep-vein thrombosis and mortality among critically ill patients: a post hoc analysis of PREVENT trial.

BACKGROUND: This study assessed the mobility levels among critically ill patients and the association of early mobility with incident proximal lower-limb deep-vein thrombosis and 90-day mortality. METHODS: This was a post hoc analysis of the multicenter PREVENT trial, which evaluated adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis with an expected ICU stay ≥ 72 h and found no effect on the primary outcome of incident proximal lower-limb deep-vein thrombosis. Mobility levels were documented daily up to day 28 in the ICU using a tool with an 8-point ordinal scale. We categorized patients according to mobility levels within the first 3 ICU days into three groups: early mobility level 4-7 (at least active standing), 1-3 (passive transfer from bed to chair or active sitting), and 0 (passive range of motion). We evaluated the association of early mobility and incident lower-limb deep-vein thrombosis and 90-day mortality by Cox proportional models adjusting for randomization and other co-variables. RESULTS: Of 1708 patients, only 85 (5.0%) had early mobility level 4-7 and 356 (20.8%) level 1-3, while 1267 (74.2%) had early mobility level 0. Patients with early mobility levels 4-7 and 1-3 had less illness severity, femoral central venous catheters, and organ support compared to patients with mobility level 0. Incident proximal lower-limb deep-vein thrombosis occurred in 1/85 (1.3%) patients in the early mobility 4-7 group, 7/348 (2.0%) patients in mobility 1-3 group, and 50/1230 (4.1%) patients in mobility 0 group. Compared with early mobility group 0, mobility groups 4-7 and 1-3 were not associated with differences in incident proximal lower-limb deep-vein thrombosis (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI] 0.16, 8.90; p = 0.87 and 0.91, 95% CI 0.39, 2.12; p = 0.83, respectively). However, early mobility groups 4-7 and 1-3 had lower 90-day mortality (aHR 0.47, 95% CI 0.22, 1.01; p = 0.052, and 0.43, 95% CI 0.30, 0.62; p < 0.0001, respectively). CONCLUSIONS: Only a small proportion of critically ill patients with an expected ICU stay ≥ 72 h were mobilized early. Early mobility was associated with reduced mortality, but not with different incidence of deep-vein thrombosis. This association does not establish causality, and randomized controlled trials are required to assess whether and to what extent this association is modifiable. TRIAL REGISTRATION: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103 (registered on 3 November 2013) and Current controlled trials, ID: ISRCTN44653506 (registered on 30 October 2013).

A Study of 42 Partially Edentulous Patients with Single-Crown Restorations and Implants to Compare Bone Loss Between Crestal and Subcrestal Endosseous Implant Placement.

BACKGROUND The purpose of the study was to evaluate the influence of dental implant placement at different bone levels upon the resultant postoperative peri-implant bone loss. MATERIAL AND METHODS Forty-two partially edentulous patients seeking implant-supported single-crown restorations were screened followed by segregation into 2 groups (GP), GP E (equicrestal) and GP S (subcrestal) (n=21 each). Sixty endosseous implants (30 each) (Adin Tourage-S, Israel), size 3.5/8 and 4/10 mm for mandibles, were placed using a 2-stage surgical procedure. At 4 to 6 months, straight abutments were attached followed by restoration (Vita Zahnfabrik, Germany). Crestal bone levels (mesial/distal) of implant fixtures were assessed at 5 time intervals (after surgery, and at 3, 6, 9, and 12 months) using digital radiography. Means and standard deviations were calculated, following which the differences were statistically analyzed using ANOVA at P value of <0.05. RESULTS The mean annual bone loss for GP S (1.96 mm) was higher than GP E (1.10 mm). At all studied time intervals, the bone loss for implants in GP S was higher than in GP E (P<0.05). Between time intervals, lowest bone loss was observed on the distal side in GP E (0.11 mm/6-9 month) and the highest bone loss was observed on the distal side of GP S (0.6 mm/9-12 month). Differences in the means between the 2 groups on mesial and distal sides were statistically significant at all time intervals (P<0.05). CONCLUSIONS Subcrestal implant placement was associated with more bone loss than when implants are placed at the crestal level.

Using feed-forward perceptron Artificial Neural Network (ANN) model to determine the rolling force, power and slip of the tandem cold rolling.

In this paper, an Artificial Neural Network (ANN) is used to investigate the influence of rolling parameters such as thickness reduction, inter-strand tension, rolling speed and friction on the rolling force, rolling power, and slip of tandem cold rolling. For this reason, the rolling power was derived for 195 various experiments through a series of observation tests. The network is trained and tested using real data collected from a practical tandem rolling line. The best topology of the ANN is determined by Broyden-Fletcher-Goldfarb-Shanno (BFGS) training algorithm and error, and nine neurons in the hidden layer had the best performance. The average of the training, testing, and validating correlation coefficients data sets are mentioned 0.947, 0.924, and 0.943, respectively. The obtained results show MSE value 4.2 × 10-4 for predicting slip. In addition, the effect of friction and angular velocity condition on the cold rolling critical slip phenomena are investigated. The results show that ANNs can accurately predict the cold rolling parameters considered in this study.

Perceptions, motivation factors, and barriers to a COVID-19 booster immunization in a subpopulation of KSA: A cross-sectional study.

The current cross-sectional survey was designed to evaluate the perception, motivation factors and barriers to a COVID-19 booster immunization in a subpopulation of the Kingdom of Saudi Arabia. A total of 520 respondents were selected by a simple random sampling method. The questionnaire was designed in multiple languages and categorized as; demographic details, perceptions, motivation factors, and barriers to acceptance of a booster dose of COVID-19 vaccine among the respondents. Both anonymous, self-administered, closed-ended online, and paper-based questionnaire was used to assess the above parameters. A higher proportion of the respondents were females (55.2%) with an age range of 36.7 ±â€…7.7 years. About 36.2% of respondents had a poor perception of the booster dose. Significant differences in the levels of perceptions were found among different age groups and also among the respondents with or without chronic medical conditions. Nearly 49.8% of respondents had hesitation about the booster dose, 58.8% of respondents recommended others to get the booster vaccine at the earliest and 49.8% preferred to develop natural immunity to infection. The hesitation for the booster was more among the female respondents and the older age groups (≥ 60 years) though a large number (43.2%) believe that the booster vaccination is going to end the pandemic worldwide. Further nationwide studies involving different subpopulations are recommended. Public health education is the need of the hour to reduce such barriers and hesitancy.

Recent Progress in Aptamer-Functionalized Metal-Organic Frameworks-Based Optical and Electrochemical Sensors for Detection of Mycotoxins.

Mycotoxin contamination in foodstuffs and agricultural products has posed a serious hazard to human health and raised international concern. The progress of cost-effective, facile, rapid and reliable analytical tools for mycotoxin determination is in urgent need. In this regard, the potential utility of metal-organic frameworks (MOFs) as a class of crystalline porous materials has sparked immense attention due to their large specific surface area, adjustable pore size, nanoscale framework structure and good chemical stability. The amalgamation of MOFs with high-affinity aptamers has resulted in the progress of advanced aptasensing methods for clinical and food/water safety diagnosis. Aptamers have many advantages over classical approaches as exceptional molecular recognition constituents for versatile bioassays tools. The excellent sensitivity and selectivity of the MOF-aptamer biocomposite nominate them as efficient lab-on-chip tools for portable, label-free, cost-effective and real-time screening of mycotoxins. Current breakthroughs in the concept, progress and biosensing applications of aptamer functionalized MOFs-derived electrochemical and optical sensors for mycotoxins have been discussed in this study. We first highlighted an overview part, which provides some insights into the functionalization mechanisms of MOFs with aptamers, offering a foundation to create MOFs-based aptasensors. Then, we discuss various strategies to design high-performance MOFs-based aptamer scaffolds, which serve as either signal nanoprobe carriers or signal nanoprobes and their applications. We perceived that applications of optical aptamers are in their infancy in comparison with electrochemical MOFs-derived aptasensors. Finally, current challenges and prospective trends of MOFs-aptamer sensors are discussed.

The frequency and pattern of deranged lipid profile in patients with ischemic stroke: a retrospective study.

BACKGROUND AND AIM: Ischemic Stroke has been recognized as the principal cause of disability and the third leading cause of mortality worldwide. The aim of this study was to determine the frequency and pattern of dyslipidemia in patients presenting with ischemic stroke at a tertiary care hospital in Karachi, Pakistan and to evaluate the effect of demographic and clinical factors on the frequency and pattern of dyslipidemia in ischemic stroke subjects.   Methods: A cross-sectional study carried on a sample size of 235 patients presenting to the out-patient clinic with paralysis, difficulty in speech, and/or loss of consciousness lasting for one hour or more. Blood samples were analyzed for total cholesterol (TC), triglycerides (TG), low-density lipoproteins (LDL), very low-density lipoproteins (VLDL) and high-density lipoproteins (HDL) by the enzymatic colorimetric methodology. These values were recorded on the pre-defined proforma by the investigators. All analysis was performed using SPSS version 23.0.   Results: The average age of the patients was 50.84±11.51 years and 62.1% of them were males. The frequency of dyslipidemia was observed in more than half (n=134/235, 57.02%) of ischemic stroke patients. Regarding the dyslipidemia pattern, TC, VLDL-C and TG levels were deranged in more than 50% of the cases. The most commonly deranged values were of TC and VLDL-C, followed by TG levels. It was observed that patients with a previous history of DM (73.9%, p=0.002) and HTN (81.3%, p=0.001) had significantly higher rates of deranged lipid profiles. Lipid values were found to be more deranged in patients aged 41-50 years (p=0.002) however, no statistically significant differences were observed with respect to BMI (p=0.192) and symptoms duration (p=0.334).   Conclusions: Dyslipidemia is an important risk factor for ischemic stroke, and elevated LDL-C is usually the lipid fraction implicated in the pathologic mechanism of stroke.

The effect of intermittent pneumatic compression on deep-vein thrombosis and ventilation-free days in critically ill patients with heart failure.

There are contradictory data regarding the effect of intermittent pneumatic compression (IPC) on the incidence of deep-vein thrombosis (DVT) and heart failure (HF) decompensation in critically ill patients. This study evaluated the effect of adjunctive use of IPC on the rate of incident DVT and ventilation-free days among critically ill patients with HF. In this pre-specified secondary analysis of the PREVENT trial (N = 2003), we compared the effect of adjunctive IPC added to pharmacologic thromboprophylaxis (IPC group), with pharmacologic thromboprophylaxis alone (control group) in critically ill patients with HF. The presence of HF was determined by the treating teams according to local practices. Patients were stratified according to preserved (≥ 40%) versus reduced (< 40%) left ventricular ejection fraction, and by the New York Heart Association (NYHA) classification. The primary outcome was incident proximal lower-limb DVT, determined with twice weekly venous Doppler ultrasonography. As a co-primary outcome, we evaluated ventilation-free days as a surrogate for clinically important HF decompensation. Among 275 patients with HF, 18 (6.5%) patients had prevalent proximal lower-limb DVT (detected on trial day 1 to 3). Of 257 patients with no prevalent DVT, 11/125 (8.8%) patients in the IPC group developed incident proximal lower-limb DVT compared to 6/132 (4.5%) patients in the control group (relative risk, 1.94; 95% confidence interval, 0.74-5.08, p = 0.17). There was no significant difference in ventilator-free days between the IPC and control groups (median 21 days versus 25 days respectively, p = 0.17). The incidence of DVT with IPC versus control was not different across NYHA classes (p value for interaction = 0.18), nor across patients with reduced and preserved ejection fraction (p value for interaction = 0.15). Ventilator-free days with IPC versus control were also not different across NYHA classes nor across patients with reduced or preserved ejection fraction. In conclsuion, the use of adjunctive IPC compared with control was associated with similar rate of incident proximal lower-limb DVT and ventilator-free days in critically ill patients with HF.Trial registration: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103 (registered on 3 November 2013, https://clinicaltrials.gov/ct2/show/study/NCT02040103 ) and Current controlled trials, ID: ISRCTN44653506 (registered on 30 October 2013).

Oral health knowledge, attitude, and practice of pregnant women in Deccan, South India: a cross-sectional prenatal survey.

Pregnancy is a unique condition for women, associated with physiological and emotional changes in the body. Various research showed an association between periodontal disease and adverse pregnancy outcomes. Importance to hygiene maintenance should be given during pregnancy and improve the wellbeing of the mother and child. This study assessed oral health knowledge, attitude, and practices among pregnant women in Hyderabad. The study design was cross-sectional and included 445 women who responded and completed the survey. Subjects were selected using a random sampling technique in gynecology clinics. The questionnaire form consisted of four sections: demographic data, knowledge, attitude, and oral hygiene practice. Out of the 482 pregnant females invited to participate in the study, 445 women completed the survey, giving a response rate of 92%. The majority of women showed good knowledge and attitude regarding oral hygiene and its relation to pregnancy. However, the participants showed poor compliance with the recommended protocol. There are certain myths and barriers to dental treatment that need to be considered in the prenatal education of women. If explained by the gynecologist, the importance of oral health and its correlation with systemic health will play a crucial role in improving oral hygiene practice and regular dental visits.

Characteristics and outcome of tertiary care critically ill COVID-19 patients with multiple comorbidities admitted to the intensive care unit.

PURPOSE: We conducted this study to evaluate the characteristics and outcomes exclusively in high-risk coronavirus disease 2019 (COVID-19) tertiary care patients with multiple comorbidities, as very few have reported outcomes in this specific cohort. METHODS: All patients, with two or more risk factors for COVID-19 and Charlson Comorbidity Index (CCI) of >2, who were admitted to intensive care unit (ICU) between March and December 2020 were included. Their characteristics, ICU course, and outcomes as well as differences between nonsurvivors and survivors were evaluated. The primary outcome was all-cause 28-day mortality. RESULTS: Out of 1152 COVID-19 patients, 101 met the inclusion criteria. The patients had an average of 4 or more comorbidities with a very high CCI of 5. The 28-day all-cause mortality was 23% and inhospital mortality was 32%. Among all risk factors, only age > 70 years, male gender, and chronic kidney disease were significant determinants of mortality (P < 0.03). Admission PaO2/FiO2 ratio and elevated inflammatory markers were same among survivors and nonsurvivors (P > 0.66). The mean time from presentation to ICU admission (59 vs. 38 h), APACHE II score (20.5 vs. 17), ICU length of stay (25 vs. 12 days), and hospital length of stay (28 vs. 20 days) were all higher in nonsurvivors as compared to survivors, respectively (P < 0.03). Fifty-four percent of the patients were intubated and had higher 28-day (40%) and inhospital (55%) mortality. CONCLUSION: Tertiary care patients with multiple comorbidities have higher mortality than what is reported for mixed populations. Further studies are needed to determine realistic mortality benchmarks for these patients.

Too early for admission? A Telemedicine follow up comparison of mild COVID-19 patients from the Emergency Department and Clinics.

OBJECTIVE: Mildly symptomatic COVID-19 patients may seek medical attention either in the Emergency Department (ED) or Ambulatory Clinics (AC). However, it is unclear if ED patients have different characteristics and outcomes than AC patients when discharged under telemedicine surveillance, which we explored in this study. METHODS: Patients with mild or asymptomatic COVID-19 disease referred to a multidisciplinary Telemedicine clinical service (TM-CS) program in an urban tertiary-care hospital, between June 2020 and February 2021, were evaluated. Those referred from ED were labeled "ED Group" and ones from AC as "AC Group." Their characteristics, clinical features and outcomes including telemedicine parameters, subsequent ED visits, hospital admission, oxygen requirements, intensive care unit (ICU) admission, and mortality were compared. RESULTS: Out of 1132 confirmed non-admitted COVID-19 patients, 526 with mild (89%) or asymptomatic (11%) disease were enrolled in TM-CS. Majority of these were referred from ED (n = 370; 70%) and rest (n = 156, 30%) from the AC. Patients in the ED group compared to AC group, had higher BMI (28.9 vs. 27.5), higher Charlson Comorbidity Index (1.4 vs. 0.9), and higher incidence of comorbidities (50% vs. 22%), P ≤ 0.01. However, there were no differences in the ED and AC groups in subsequent ED visits (26% vs. 24%), hospital admission (18% vs. 15%), oxygen requirements (5% vs. 4%), ICU admission (1% vs. 2%), and mortality (0.3% vs. 0.6%), respectively (P > 0.40). CONCLUSION: Significant number of mild COVID-19 patients head to the ED for initial assistance but have similar outcomes to AC patients. TM-CS could be a safe alternative for follow-up monitoring of these patients.

Some Valency Oriented Molecular Invariants of Certain Networks.

BACKGROUND: The valency of an atom in a molecular structure is the number of its neighboring atoms. A large number of valency based molecular invariants have been conceived, which correlate certain physio-chemical properties like boiling point, stability, strain energy and many more chemical compounds. OBJECTIVE: Our aim is to study the valency based molecular invariants for four hexa chemical structures, namely hexagonal network, honeycomb network, oxide network and silicate sheet network. METHODS: We use the technique of atom-bonds partition according to the valences of atoms to find results. RESULTS AND CONCLUSION: Exact values of valency-based molecular invariants, namely the Randi index, atom bond connectivity index, geometric arithmetic index, harmonic index, Zagreb indices, Zagreb polynomials, F-index and F-polynomial, are found for four hexa chemical structures.

From Epidemic to Pandemic: Comparing Hospital Staff Emotional Experience Between MERS and COVID-19.

Objective: Both Middle East Respiratory Syndrome (MERS) and Coronavirus Disease 2019 (COVID-19) have an emotional toll on healthcare workers (HCWs), but the difference of the impact between the two diseases remains unknown.Design: A cross sectional descriptive survey.Setting: A tertiary care hospital.Participants: 125 HCWs who worked during the 2014 MERS as well as the 2020 COVID-19 outbreaks in high-risk areas of the hospital including critical care, emergency room and COVID-19 clinics.Methods: The comprehensive survey comprised 5 sections and 68 questions and was administered to HCWs before availability of the COVID-19 vaccine. The survey evaluated hospital staff emotions, perceived stressors, external factors that reduced stress, personal coping strategies, and motivators for future outbreaks. The participants rated each question for MERS and COVID-19 simultaneously on a scale from 0-3. The responses were reported as mean and standard deviation, while Wilcoxon signed-rank test was used to calculate the difference in responses.Results: There were 102 (82%) participants who returned the questionnaire. The ritual of obsessive hand washing, emotional and physical fatigue, ongoing changes in infection control guidelines, fear of community transmission, and limitations on socialization and travel were the major stressors that were significantly worse during COVID-19 compared to MERS (P<0.05) and led to HCWs adoption of additional 'personal' coping strategies during COVID-19. There was no difference between COVID-19 and MERS, however, among preferences for 'external' factors made available to HCWs that could reduce stress or in their preferences for motivators to work in future outbreaks (P>.05).Conclusion: Both the MERS and COVID-19 outbreaks were emotionally draining for HCWs. However, COVID-19 was a relatively more stressful experience than MERS for HCWs and led to greater personal, behavioral, and protective adaptations by the hospital staff.

Telemedicine monitoring of high-risk coronavirus disease 2019 (COVID-19) patients by family medicine service after discharge from the emergency department.

BACKGROUND: Up to 25% of the total coronavirus disease 2019 (COVID-19) admissions comprise patients with comorbidities who present to the emergency department (ED) with only mild-to-moderate disease. It is unclear whether as an alternative to hospitalization, telemedicine can be used to monitor these "high-risk" comorbid patients. The aim of our study was to answer this question by comparing the outcome of such patients discharged under a family medicine service (FMS) telemonitoring program and those admitted to hospital. MATERIALS AND METHODS: Patients with three or more risk factors for progression to severe COVID-19 disease were designated as "high-risk" in our study. In the absence of acute indication for hospitalization, these high-risk patients with mild-to-moderate disease were discharged home under the supervision of FMS led telemonitoring between October 2020 and February 2021 and were labelled as "Telemedicine group." They were compared to similar patients who were admitted to hospital between March-August 2020 before the implementation of telemedicine service (TMS) and were taken as "Control group." Outcome measures included intubation, number of inpatient days, 28-day mortality and cost analysis for the two groups. RESULTS: Out of 572 COVID-19 patients who presented to the ED, 70 met the inclusion criteria for the "Telemedicine Group" and 35 were included in the "Control Group". In the Telemedicine group, 21 (30.0%) patients were brought back to ED for re-evaluation and 16 (22.9%) were eventually admitted to the hospital. There was no difference in terms of oxygen requirements, intubation, and intensive care unit admission (P > 0.74) between the groups, and none of the study patients died. The Family Medicine-led TMS saved 77% inpatient admissions and on average 4.4 hospital days and $3400 per patient (P < . 0001). CONCLUSION: Family medicine-led telemonitoring of high-risk COVID-19 patients presenting to the ED with mild-to-moderate disease is a feasible and cost-effective alternative to hospitalization.

Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome.

BACKGROUND: Both coronavirus disease 2019 (COVID-19) and Middle East respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, their ARDS course and characteristics have not been compared, which we evaluate in our study. METHODS: MERS patients with ARDS seen during the 2014 outbreak and COVID-19 patients with ARDS admitted between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared. RESULTS: Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, obese, had significantly higher initial C-reactive protein (CRP), more likely to get trial of high-flow oxygen, and had delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, fraction of inspired oxygen, peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the ICU (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were very high. CONCLUSIONS: Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients may explain the steroid responsiveness in this population.

Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades.

BACKGROUND: Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan. AIMS: Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons. METHOD: We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria. RESULTS: Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide ('wheat pills') was a preferred agent in North Punjab, whereas paraphenylenediamine ('kala pathar') was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison. CONCLUSIONS: Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.