Comparative assessment of high-risk cardiovascular medication knowledge between practising and student nurses: a descriptive multi-centre study.

Aim To examine unexplored knowledge of cardiovascular highrisk medications and perception thereof among practising nurses and students in the Kingdom of Saudi Arabia (KSA). Methods The multicentre cross-sectional quantitative study used an online survey dichotomised into a knowledge test (true/false and multiple choice questions) and a perception assessment (closed-ended questions). Four hundred and eighteen nurses participated in the study. Results In the knowledge test, 19 (4.5%) participants scored high (≥71%), while 83 (19.8%) and 316 (75.5%) demonstrated moderate (score ≥51-70%) and poor performance (score ≤50%), respectively. In a comparative analysis, the knowledge level of staff nurses was significantly higher than the students but not the other nurses' cohort. Nurses' specialty and region of KSA were strongly associated with the knowledge level. Emergency room nurses and those belonging to the eastern region of KSA exhibited higher knowledge levels than other subgroups. A vast majority of nurses, 128 (30.6 %), rated their knowledge of medicines as somewhat sufficient, while quoting insufficient knowledge 226 (54.1%) as the major cause of medication errors. Three hundred and sixteen (75%) nurses expressed interest in undergoing specialised training in high-alert medication-based therapy preferably in a classroom setting by 279 (66.7%). Conclusion This study revealed a marked knowledge deficit in high-risk cardiovascular drugs among nurses. The pharmacological curriculum in nursing schools should be tailored to be clinically oriented and reinforced with problem-based learning. Continued pharmacology education focusing on high-risk drugs should be implemented among nurses to safeguard patient lives by mitigating the risks of medication error.

Impact of COVID-19-Related Personal Protective Equipment Changes on Dental Education: A Qualitative Study to Explore Faculty and Student Perspective.

Background: COVID-19 pandemic and its related personal protective equipment have impacted all aspects of dental education. The qualitative study assesses the impact of COVID-19-related changes and their effects on students' clinical learning from student and faculty perspectives. Methods: This qualitative study involved third- and fourth-year predoctoral dental students and full-time dental clinical faculty. A semistructured interview guide was used. The interview guide consisted of seven open-ended questions about the impact of the new COVID-19-related infection control procedures on students' learning experience in the dental clinic. Interviews were recorded, transcribed verbatim, and analyzed using a basic interpretative approach by two independent researchers. Emerged themes were identified. Results: Twelve faculty members and 21 students participated in six focus groups. Three major themes emerged from the analysis: learning challenges, learning opportunities, and long-term impact. Students identified four categories of learning challenges: communication, visualization, clinical exposure, and heat. Five learning challenges identified by faculty were: faculty burnout, service delivery challenges, material wastage, teaching difficulties, and lack of comprehensive care. The five learning opportunities students identified were autonomy, preparedness, efficiency, safety, and personalized feedback. Learning opportunities identified by faculty were time management, autonomy, and preparedness. Three categories of long-term impact on students identified were future opportunities, adaptation, and postgraduation plans. Faculty identified apathy, career re-evaluation, and adaption as the long-term impact of COVID-19-related changes. Conclusion: Although the new COVID-19-related infection control procedures and regulations in the dental school clinical setting come with learning challenges, students and faculty also saw learning opportunities through increased autonomy, preparedness, and efficiency. The impact of COVID-19 extends beyond the current learning experiences as it may modify students' long-term plans.

Dietary Intake patterns in women with GDM and Non-GDM: A comparative study.

Objectives: The study aimed to determine dietary Intake patterns in women with GDM and Non-GDM, a comparative study in a tertiary care hospital, Pakistan. Methods: This comparative cross sectional study was conducted through questionnaire spread over a period of six months of pregnant women visiting to Abbasi Shaheed Hospital for ante-natal visit having 24 to 28 weeks of gestation. With the written consent of the participants dietary intake patterns were assessed in GDM & Non-GDM subjects by a three day 24 hours' recalls and food frequency questionnaire. A 24-hour dietary recall chart is a dietary assessment tool in which participants were asked to recall all food and drink they have consumed in the last 24 hours. The FFQ (food frequency questionnaire) provide a list of foods and participants were asked how often they eat each item on the list. This FFQ has 70 food items. The food frequency was reported as never, per year, per month, once a week, once and a day. The reported intake of food was converted into nutrients intake (carbohydrate, protein, fat) which was calculated by reported intake frequency of each food multiplied by reported portion size and its respective nutrient composition, summing over all foods by a trained Nutritionist. Results: A total of 75 participants with GDM, and 75 with Non-GDM were enrolled in this study over a period of six months. It was observed that dietary intake patterns have a significant association with GDM. Those who consume carbohydrate mainly containing diet have likely to have GDM. It has been seen that those who have family history of diabetes are more likely to have GDM. Family dietary patterns can affect risk of GDM. Our study has shown that timings of meals did not find have any significant association with GDM. Conclusion: Dietary patterns strongly influence the risk of GDM. The most contributing factors to risk of GDM are higher intake of carbohydrate rich diet and lesser consumption of fruits and vegetables.

Impact of brushing with charcoal on tooth color and enamel loss: An in vitro study.

PURPOSE: To evaluate the whitening efficacy of charcoal powder compared to a whitening toothpaste and the surface loss using scanning electron microscopy (SEM) and confocal laser scanning microscope (CLSM). METHODS: 60 human extracted teeth were randomly assigned to two groups: Treatment (T, charcoal group: Premium Nature) and Control (C, whitening toothpaste group: Colgate Optic White). Teeth in the treatment group were brushed with a charcoal paste. Teeth shade was evaluated before and after the intervention. Lightness was assessed using both VITA classical shade guide and VITA Easyshade V. Changes within and between the group were evaluated by the paired-sample t-test and independent sample t-test. Surface roughness (Ra) of samples was performed using SEM, and to assess surface loss a CLSM was used. RESULTS: At baseline, there were no significant differences in teeth lightness, chroma, or hue between both the charcoal and the whitening toothpaste groups (P> 0.05). After 21 days of brushing, teeth brushed with the whitening toothpaste were significantly lighter (VITA Easyshade mean score: 78.34, SD: 8.397; VITA classical A1-D4 shade mean: 8.90, SD: 4.475) than the charcoal group (VITA Easyshade mean: 69.70, SD: 6.364; VITA classical A1-D4 shade mean: 11.77; SD: 3.421) (P< 0.001). In addition, there was a significant reduction in lightness (i.e., increase in darkness) within the charcoal group after the intervention (P< 0.001). There was no significant difference in chroma and hue between the charcoal and the whitening toothpaste groups (P> 0.05). There was no significant tooth loss nor roughness change (P= 0.867) for both groups when compared with natural tooth structure. Brushing teeth with the charcoal paste tested for 21 days had no effect on tooth lightness, chroma, or hue. Charcoal powder had no significant effect on tooth surface roughness. CLINICAL SIGNIFICANCE: The Premium Nature charcoal toothpaste tested had no tooth whitening effect.

A cross-sectional study of dental students perception of dental faculty gender differences.

OBJECTIVE: The objective of this study was to evaluate students' perceptions of differences in learning from faculty of different gender. METHOD: This cross-sectional study involved pre-doctoral dental students (years 2 to 4) who had a simulation and/or clinical experience working with dental faculty for at least one year. Students completed a self-administered questionnaire with three sections: demographic, difference between faculty related to their knowledge, skill, critical thinking, acceptance of cultural differences, and students' preferences in working with faculty in specialty clinics. RESULTS: A total of 136 students completed the survey (75.4% response rate). Participants were 52.6% women, 62.2% self-identified as Caucasian/White. Students reported that female faculty are more understanding (p = 0.001) and accepting of cultural differences (p<0.001) compared to male faculty (p<0.05). Students reported perceiving female faculty more as being a role model than male faculty (p = 0.034). When comparing male and female students, male student's perception of male faculty as a role model was significantly higher than female students (p<0.05). There was no significant difference in student's perceptions between male and female faculty in their knowledge, skills, compassion, critical thinking, providing feedback, communication skills, and grading (p>0.05). Caucasian/White students perceived female faculty as more encouraging for discussions and male faculty as more rigid/inflexible (p<0.05). CONCLUSIONS: Students perceived female faculty as more understanding and culturally competent compared to male faculty. There were no significant differences in student's perceptions of male and female faculty in their knowledge, skills, compassion, critical thinking, feedback, communication skills, and grading. Students perceived female faculty as role models more than male faculty.

Exogenously-applied L-glutamic acid protects photosynthetic functions and enhances arsenic tolerance through increased nitrogen assimilation and antioxidant capacity in rice (Oryza sativa L.).

L-Glutamic acid (Glu) is used as an effective bio-stimulant to reduce arsenic (As) stress in plants. The role of Glu was studied in the protection of photosynthesis and growth of rice (Oryza sativa L. Japonica Type Taipie-309) plants grown with 50 µM As stress by studying the oxidative stress, photosynthetic and growth characteristics. Among the Glu concentrations (0, 2.5, 5 and 10 µM), 10 µM Glu maximally enhanced photosynthesis and growth parameters with the least cellular oxidative stress level. The supplementation of 10 µM Glu resulted in the reduced effects of As stress on gas exchange parameters, PSII activity and growth attributes through enhancement of antioxidant and proline metabolism. The enzymes of nitrogen (N) assimilation, such as nitrate reductase, nitrite reductase, glutamine synthetase and glutamate synthase were increased with Glu treatment under As stress. The Glu-induced metabolite synthesis showed the role of various metabolites in As stress responses. The role of Glu as a signalling molecule in reducing the adverse effects of As through accelerating the antioxidant enzymes, PSII activity, proline metabolism and nitrogen assimilation has been discussed.

Correlation between Random Urinary Protein-to-creatinine Ratio and 24-h Urinary Protein Excretion in Preeclampsia.

This study aimed to determine the correlation between random urinary protein-to-creatinine ratio in single-voided urine samples and 24-h urinary protein excretion in pregnant women with preeclampsia. A cross-sectional study was conducted at the Department of Gynecology and Obstetrics, Abbasi Shaheed Hospital, Karachi, Pakistan, from July 2019 to June 2020. Fifty women with singleton pregnancy after 20 weeks of gestation with hypertension and 2+ proteinuria or more, according to a dipstick test, were included. Those with chronic hypertension; preexisting renal disease; gestational diabetes; eclampsia; hemolysis, elevated liver enzymes, a low platelet count syndrome; and coexisting urinary tract infections were excluded. Two random urine samples taken at 9:00 a.m. and 2:00 p.m. and 24-h urine samples were collected to evaluate the random urinary protein-to-creatinine and the 24-h protein excretion, respectively. The correlation coefficient (r) between them was calculated using Pearson's correlation test. The patients' mean age was 28.58 ± 5.09 years and their mean gestational age was 32.74 ± 4.44 weeks. Twenty-eight (56%) women were primigravidas, and 22 (44%) were multiparous. The average serum creatinine was 0.80 ± 0.16 mg/dL. The mean random urinary protein-to-creatinine ratio was 0.93 ± 0.7 mg/mg, and the mean 24-h urine was 481.08 ± 20.10 mL. A strong positive correlation was found between the protein-to-creatinine ratio and 24-h urinary protein excretion (r = 0.655; P = 0.01). We concluded that the protein-to-creatinine ratio in spot urine samples could be used as an alternative to in 24-h collection of urine to determine protein excretion in preeclamptic pregnant women.

Efficacy of MI Paste® on Bleaching-Related Sensitivity: Randomized Clinical Trial.

BACKGROUND: To evaluate the effectiveness of MI Paste® in reducing sensitivity associated with vital tooth bleaching. METHODS: This randomized controlled split-mouth clinical trial included 45 subjects that were randomly divided into two groups. In Group 1, the maxillary arch was the control arch (only bleaching), while the mandibular arch was the intervention arch (bleaching and MI Paste®). In Group 2, the mandibular arch was the control arch (only bleaching), while the maxillary arch was the intervention arch (bleaching and MI Paste®). Subjects started with the control arch and then switched to the intervention arch after two weeks. Subjects were instructed to use MI Paste® in a custom tray for 5 minutes, wait for 1 hour, and then bleach overnight using a different tray. Sensitivity was measured using both a thermal sensitivity test and a daily log of sensitivity for 14 days. Shade was evaluated using a colorimeter and a shade guide. RESULTS: Immediately after treatment, the thermal test sensitivity scores for the arches bleached without MI Paste® were greater than those with MI Paste® (p=0.011). Arches not receiving the MI Paste® treatment showed significantly higher VAS sensitivity scores during the 14-day period of bleaching (p=0.002). The mean score for the 14-day period was 37.9 for the arches not treated with MI Paste® versus 27.5 for the treated arches. Both the intervention group and the control group showed significantly lighter shade relative to baseline (p < 0.001) with no significant difference between them (p=0.42). CONCLUSION: MI Paste® significantly reduced the sensitivity associated with bleaching and did not interfere with shade change.

Digital social support for undergraduate students during COVID-19: Pivotal support for the digital transformation.

BACKGROUND: In a time of crisis, such as the COVID-19 pandemic, digital social support can prove helpful in buffering the stress and anxiety especially for students whose lives were being affected both socially and academically. The present study aims to explore the emotional and informational social support available to students during the online transformation of their education. It further investigates factors affecting anxiety and stress among students. DESIGN AND METHODS: An online survey was administered among 479 undergraduate students at a private university in Saudi Arabia from 2nd March till 17th June 2020. Descriptive analysis was used to report the findings of students' self-reported data. RESULTS: The results revealed that more than 70% of the students reported that they were satisfied with the informational and emotional support available to them via digital platforms. However, they felt less connected with the teachers and academic administration. Feeling sick (46%), being locked down at homes and isolation (43%) were major causes of stress and anxiety. 71% of the students reported their ability to keep themselves busy, however, only 55% of students mentioned that they did not feel lonely while confined to their homes. In these circumstances, the continuation of studies via online platforms helped students reduce stress and anxiety (52%). CONCLUSIONS: Although this online transformation was not planned, the university was able to provide adequate informational support to the students. However, students were dependent upon friends, family and relatives for emotional support. The results of the study point towards the need of training for teachers and academic administrative staff in order to better address students' needs for social support during the crisis.  The results also contribute to the body of data reporting the various effects of the COVID-19 pandemic on students in a way to reach a sustainable framework for supporting students.

Physiological, Biochemical and Reproductive Studies on Valeriana wallichii, a Critically Endangered Medicinal Plant of the Himalayan Region Grown under In-Situ and Ex-Situ Conditions.

Valeriana wallichii, a perennial herb belonging to family Valerianaceae, is an important medicinal herb of the Himalayan region. The incessant exploitation of nature for meeting the demands of the pharmaceutical industry has put unbearable pressure on its natural habitats. A study on its physiological, biochemical, growth and reproductive attributes was planned. Physiological study revealed that ex-situ (outside their natural habitat) populations faced severe stress as compared to in-situ (natural habitat) plants. The difference in the performance of these habitat plants was related to superoxide and H2O2 in the leaves. Photosynthetic attributes were increased in in-situ populations. Proline content and its biosynthetic enzymes ornithine aminotransferase, and pyrroline-5-carboxylate reductase showed an increase in ex-situ plants; proline oxidase decreased. Glucose-6-phosphate dehydrogenase, shikimic acid dehydrogenese, phenylalanine lyase, and flavonoids content showed an increment in ex-situ plants. Antioxidants enzyme superoxide dismutase, catalase, ascorbate peroxidase and reduced glutathione showed an increment in ex-situ conditions. Growth and reproductive attributes were more in ex-situ plants. The observations made are suggestive that a comprehensive conservation programme involving in-situ as well as ex-situ strategies will be effective for the conservation and long term survival of the species.

Polymorphisms in the Toll-Like Receptor and the IL-23/IL-17 Pathways Were Associated with Susceptibility to Inflammatory Bowel Disease in a Danish Cohort.

BACKGROUND: The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), result from the combined effects of susceptibility genes and environmental factors. Previous studies have shown that polymorphisms in the Toll-like receptor (TLR), the apoptosis, the IL-23/IL-17 and the interferon gamma (IFNG) pathways are associated with risk of both CD and UC. METHODS: Using a candidate gene approach, 21 functional single nucleotide polymorphisms (SNPs) in 15 genes were assessed in a clinical homogeneous group of severely diseased ethnic Danish patients consisting of 624 patients with CD, 411 patients with UC and 795 controls. The results were analysed using logistic regression. RESULTS: The polymorphisms TLR5 (rs5744174) and IL12B (rs6887695) were associated with risk of CD, and TLR1 (rs4833095) and IL18 (rs187238) were associated with risk of both CD and UC (p<0.05). After Bonferroni correction for multiple testing, the homozygous variant genotype of TLR1 743 T>C (rs4833095) was associated with increased risk CD (OR: 3.15, 95% CI: 1.59-6.26, p = 0.02) and CD and UC combined (OR: 2.96, 95% CI: 1.64-5.32, p = 0.005). CONCLUSION: Our results suggest that genetically determined high activity of TLR1 and TLR5 was associated with increased risk of both CD and UC and CD, respectively. This supports that the host microbial composition or environmental factors in the gut are involved in risk of IBD. Furthermore, genetically determined high activity of the IL-23/IL-17 pathway was associated with increased risk of CD and UC. Overall, our results support that genetically determined high inflammatory response was associated with increased risk of both CD and UC.

Effectiveness of anti-tumour necrosis factor-α therapy in Danish patients with inflammatory bowel diseases.

INTRODUCTION: The objective of this study was to evaluate the outcome of anti-tumour necrosis factor-α (anti-TNF) treatment in a large cohort of patients with inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC) in clinical practice and to establish a cohort for future studies of genetic markers associated with treatment response. METHODS: A national, clinically based cohort of previously naïve anti-TNF treated patients from 18 medical departments was established. The patients were screened for tuberculosis prior to treatment initiation. By combining the unique personal identification number of Danish citizens (the CPR number) from blood samples with data from the National Patient Registry, patients with International Classification of Diseases, Version 10 (ICD-10) codes K50-K63 were identified. Treatment efficacy reflected the maximum response within 22 weeks. RESULTS: Among 492 patients with CD and 267 patients with UC, 74%/13%/14% and 65%/12%/24% were responders, partial responders and non-responders to anti-TNF therapy, respectively. More patients with UC than with CD were non-responders (odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.34-2.87, p = 0.001). Young age was associated with a beneficial response (p = 0.03), whereas smoking ≥ 10 cigarettes/day was associated with non-response among patients with CD (OR = 2.33, 95% CI: 1.13-4.81, p = 0.03). CONCLUSION: In this clinically based cohort of Danish patients with IBD treated with anti-TNF, high response rates were found. Heavy smoking was associated with non-response, whereas young age at treatment initiation was associated with a beneficial response among patients with CD. Thus, the results obtained in this cohort recruited from clinical practice were similar to those previously obtained in clinical trials. FUNDING: The work was funded by Health Research Fund of Central Denmark Region, Colitis-Crohn Foreningen and the University of Aarhus (PhD grant). TRIAL REGISTRATION: Clinicaltrials NCT02322008.

Polymorphisms in the inflammatory pathway genes TLR2, TLR4, TLR9, LY96, NFKBIA, NFKB1, TNFA, TNFRSF1A, IL6R, IL10, IL23R, PTPN22, and PPARG are associated with susceptibility of inflammatory bowel disease in a Danish cohort.

BACKGROUND: The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), result from the combined effects of susceptibility genes and environmental factors. Polymorphisms in genes regulating inflammation may explain part of the genetic heritage. METHODS: Using a candidate gene approach, 39 mainly functional single nucleotide polymorphisms (SNPs) in 26 genes regulating inflammation were assessed in a clinical homogeneous group of severely diseased patients consisting of 624 patients with CD, 411 patients with UC and 795 controls. The results were analysed using logistic regression. RESULTS: Sixteen polymorphisms in 13 genes involved in regulation of inflammation were associated with risk of CD and/or UC (p ≤ 0.05). The polymorphisms TLR2 (rs1816702), NFKB1 (rs28362491), TNFRSF1A (rs4149570), IL6R (rs4537545), IL23R (rs11209026) and PTPN22 (rs2476601) were associated with risk of CD and the polymorphisms TLR2 (rs1816702), TLR4 (rs1554973 and rs12377632), TLR9 (rs352139), LY96 (rs11465996), NFKBIA (rs696), TNFA (rs1800629), TNFRSF1A (rs4149570), IL10 (rs3024505), IL23R (rs11209026), PTPN22 (rs2476601) and PPARG (rs1801282) were associated with risk of UC. When including all patients (IBD) the polymorphisms TLR2 (rs4696480 and rs1816702), TLR4 (rs1554973 and rs12377632), TLR9 (rs187084), TNFRSF1A (rs4149570), IL6R (rs4537545), IL10 (rs3024505), IL23R (rs11209026) and PTPN22 (rs2476601) were associated with risk. After Bonferroni correction for multiple testing, both the homozygous and the heterozygous variant genotypes of IL23R G>A(rs11209026) (OR(CD,adj): 0.38, 95% CI: 0.21-0.67, p = 0.03; OR(IBD,adj) 0.43, 95% CI: 0.28-0.67, p = 0.007) and PTPN22 1858 G>A(rs2476601) (OR(CD,unadj) 0.54, 95% CI: 0.41-0.72, p = 7*10-4; OR(IBD,unadj): 0.61, 95% CI: 0.48-0.77, p = 0.001) were associated with reduced risk of CD. CONCLUSION: The biological effects of the studied polymorphisms suggest that genetically determined high inflammatory response was associated with increased risk of CD. The many SNPs found in TLRs suggest that the host microbial composition or environmental factors in the gut are involved in risk of IBD in genetically susceptible individuals.

[Eosinophilic ascites is a rare presentationpart of eosinophilic gastroenteritis]. / Eosinofil ascites er en sjælden præsentation af eosinofil gastroenteritis.

An otherwise healthy 49-year-old male was admitted due to ascites and obstipation. He had no history of atopy. He went through an extensive diagnostic workup including laparascopy and bone marrow biopsy. All the tests came out normal except for a large number of eosinophils in the blood and the ascites. The diagnosis of idiopatic eosinophilic ascites was made. After drainage spontaneous remission was achieved. Eosinophilic ascites is a rare disorder of unknown aethiology and is a part of the syndrome called eosinophilic gastroenteritis. In symptomatic patients the choice of treatment is prednisone.