Patients' expectations surrounding revision total hip arthroplasty: a literature review.

BACKGROUND: Revision total hip arthroplasties (RTHA) are associated with a higher complication rate than primary total hip arthroplasties (THA), and therefore it is important for patients to have realistic expectations regarding outcomes. The aim of this literature review was to gather and summarize the available evidence on patients' expectations following RTHA. METHODS: A literature search was conducted in PubMed, PsycINFO, Cochrane, Google Scholar, Web of Science and Embase from inception to November 2023. Articles assessing patient expectations for RTHA were included. Methodological quality was assessed by two independent reviewers using the National Heart, Lung and Blood Institute (NIH) study quality assessment tool for observational cohort and cross-sectional studies. A qualitative analysis was performed involving the summarization of study characteristics and outcomes. RESULTS: The search strategy generated 7,450 references, of which 5 articles met the inclusion criteria. Methodological quality scores ranged from 7-10. Patients had high expectations concerning future walking ability, pain and implant longevity relative to actual postoperative outcomes. A significant positive correlation was found between fulfilled expectations of pain and walking ability and patient satisfaction (r = 0.46-0.47). Only two studies assessed the fulfillment of patient expectations. Great variability was seen in the measurement of expectations. CONCLUSION: Patients undergoing RTHA appeared to have high expectations for pain and functionality compared to postoperative outcomes. However, there was a paucity of high-quality data in this area, limiting the accuracy of the conclusion. Further research is needed, that emphasizes developing a sound theoretical framework for expectations, allowing for the consistent implementation of valid measurement tools for patient expectations.

Prevalence of persistent SARS-CoV-2 in a large community surveillance study.

Persistent SARS-CoV-2 infections may act as viral reservoirs that could seed future outbreaks1-5, give rise to highly divergent lineages6-8 and contribute to cases with post-acute COVID-19 sequelae (long COVID)9,10. However, the population prevalence of persistent infections, their viral load kinetics and evolutionary dynamics over the course of infections remain largely unknown. Here, using viral sequence data collected as part of a national infection survey, we identified 381 individuals with SARS-CoV-2 RNA at high titre persisting for at least 30 days, of which 54 had viral RNA persisting at least 60 days. We refer to these as 'persistent infections' as available evidence suggests that they represent ongoing viral replication, although the persistence of non-replicating RNA cannot be ruled out in all. Individuals with persistent infection had more than 50% higher odds of self-reporting long COVID than individuals with non-persistent infection. We estimate that 0.1-0.5% of infections may become persistent with typically rebounding high viral loads and last for at least 60 days. In some individuals, we identified many viral amino acid substitutions, indicating periods of strong positive selection, whereas others had no consensus change in the sequences for prolonged periods, consistent with weak selection. Substitutions included mutations that are lineage defining for SARS-CoV-2 variants, at target sites for monoclonal antibodies and/or are commonly found in immunocompromised people11-14. This work has profound implications for understanding and characterizing SARS-CoV-2 infection, epidemiology and evolution.

HLD-DDoSDN: High and low-rates dataset-based DDoS attacks against SDN.

Software Defined Network (SDN) has alleviated traditional network limitations but faces a significant challenge due to the risk of Distributed Denial of Service (DDoS) attacks against an SDN controller, with current detection methods lacking evaluation on unrealistic SDN datasets and standard DDoS attacks (i.e., high-rate DDoS attack). Therefore, a realistic dataset called HLD-DDoSDN is introduced, encompassing prevalent DDoS attacks specifically aimed at an SDN controller, such as User Internet Control Message Protocol (ICMP), Transmission Control Protocol (TCP), and User Datagram Protocol (UDP). This SDN dataset also incorporates diverse levels of traffic fluctuations, representing different traffic variation rates (i.e., high and low rates) in DDoS attacks. It is qualitatively compared to existing SDN datasets and quantitatively evaluated across all eight scenarios to ensure its superiority. Furthermore, it fulfils the requirements of a benchmark dataset in terms of size, variety of attacks and scenarios, with significant features that highly contribute to detecting realistic SDN attacks. The features of HLD-DDoSDN are evaluated using a Deep Multilayer Perception (D-MLP) based detection approach. Experimental findings indicate that the employed features exhibit high performance in the detection accuracy, recall, and precision of detecting high and low-rate DDoS flooding attacks.

Mechanical and antibacterial properties of conventional pit and fissure sealants with addition of miswak fibers.

The occlusal surface of a tooth is affected by the development of biofilm in pits and fissures as bacteria and food particles accumulate in its complex structure. In this study, miswak fibers containing cellulose and antimicrobial extract were incorporated in commercial pit and fissure sealants. The miswak powder was characterized by different analytical techniques. The powder was mixed in different ratios (0-5%) into a pit and fissure sealant to result in five sealants (Groups 0-5), and their mechanical properties i.e. flexural strength, compressive strength, and Vickers hardness were evaluated. The sealants were also evaluated against streptococcus mutans oral pathogenic bacteria. SEM analysis confirmed irregular shape and micron-size particles of miswak powder. The infrared spectral analysis and X-ray differential peaks showed characteristic peaks related to miswak fibers. The particle appearance increased in prepared pits and fissure sealants with higher loading of miswak powder in SEM analysis. The flexural strength, compressive strength, and Vickers hardness values were obtained in the range of 148-221 (±16.6: p-value < 0.001) MPa, 43.1-50.3 MPa (±1.7: p-value <0.001), and 15.2-21.26 VHN (±0.56: p-value <0.001) for control and prepared sealant specimens respectively. In the antibacterial study, the zone of inhibitions increased with increased content of miswak from 15.6 ± 0.45 mm (Group 1) to 20.3 ± 0.32 mm (Group 5). The MIC was calculated to be 0.039%. The prepared experimental sealant had acceptable mechanical and good antibacterial properties therefore it could be recommended as an efficient pit and fissure sealant.

Severity of COVID-19 reinfection and associated risk factors: findings of a cross-sectional study in Bangladesh

BackgroundCOVID-19 reinfected patients suffer from diverse health consequences. Information on the severity of COVID-19 reinfection is scarce. The current study aimed to determine the proportion of COVID-19 reinfection and risk factors associated with its severity. MethodsThis cross-sectional study targeted all COVID-19 patients reported in May 2021 at the Health Information Unit (HIU) of the Directorate General of Health Services (DGHS) of Bangladesh. We identified 473 (1.14%) reinfected patients out of 41408 diagnosed cases by reviewing their medical records. Considering the selection criteria and informed consent, we enrolled 404 reinfected patients. Data were collected through telephone interviews and reviewing medical records using a semi-structured questionnaire and a checklist. ResultsThe majority of the reinfected patients were urban residents (98.0%). Around 13.0% of reinfected patients had <90% oxygen saturation, and 64.0% had an interval of 3-6 months between two attacks. The severity of reinfection included asymptomatic (12.9%), mild (8.9%), moderate (66.3%), and severe (11.9%) forms of infection. An interval of 3-6 months between two attacks had less chance of having mild (AOR=0.031, {rho}=0.000), moderate (AOR=0.132, {rho}=0.017), and severe (AOR=0.059, {rho}=0.002) infections. Patients who maintained physical distance had less chance of moderate-intensity reinfection (AOR=0.137, {rho}=0.013), while the vaccinated patients had a higher chance of moderate (AOR=16.127, {rho}=0.001) and severe (AOR=3.894, {rho}=0.047) intensity reinfection. ConclusionTo avert COVID-19 reinfection and its severity, patients should be vigilant about preventive practices even after recovery. The study suggests vibrant interventions aligned with exposure, physical distancing, vaccination, and comorbidities for mitigating reinfection.