COVID-19 and Intractable Hiccups: An Apparently Harmless Yet Misleading Manifestation.

COVID-19 infection typically presents with various symptoms encompassing fever, cough, and shortness of breath, with occasional reports of less common manifestations such as dizziness and persistent hiccups. Herein, we present a distinctive case wherein refractory hiccups constituted the exclusive complaint, persisting despite standard therapeutic interventions and serving as a misleading sole presentation for COVID-19 infection that, unfortunately, was complicated by septic shock and patient demise. This case prompts contemplation regarding the potential impact of hiccups on the prognosis of COVID-19. It also underscores the imperative nature of recognizing and considering atypical and uncommon presentations, as these may carry significant and even more severe consequences.

Prevalence and Associated Factors of Nomophobia Amongst the General Population in Makkah Province and Al-Madinah Province, Saudi Arabia: An Analytical Cross-Sectional Study.

Background: Nomophobia is a public health issue that involves the fear of being without a mobile phone. The study aimed to estimate the prevalence of nomophobia and its relation to psychological factors, including depression and insomnia, among the general population in Makkah Province and Al-Madinah Province, Saudi Arabia. Methods: This analytical cross-sectional study was conducted and data were obtained through a self-administered online questionnaire using the Patient Health Questionnaire-2 (PHQ-2) for depression, the Nomophobia Questionnaire (NMP-Q), and Insomnia Severity Index (ISI). Results: A total of 1022 participants completed the questionnaire. The prevalence of nomophobia was 96.7%. Moderate nomophobia was prevalent (47.8%). Based on the PHQ-2, possible depression was identified in 47.3% of the respondents. 37.1% had sub-threshold insomnia. In terms of personal psychiatric history, the most common mental disorders in the participants included generalized anxiety disorder (9.9%) and major depressive disorder (9.7%). 61.6% of them used mobile devices for more than four hours per day. Conclusion: Nomophobia is prevalent in the Makkah and Al-Madinah provinces in Saudi Arabia. The risk of nomophobia was significantly higher for participants who spent more hours using mobile devices, those with possible depression, and those having irritable bowel syndrome.

The Value of Auditing Surgical Records in a Tertiary Hospital Setting.

BACKGROUND: Assessing and improving quality of care should be of paramount importance to health care systems and providers. This study aimed to evaluate the quality of surgical records at the Jordan University Hospital. METHODS: We used the previously validated Surgical Tool for Auditing Records (STAR) to retrospectively evaluate the quality of surgical records of patients who underwent surgery in the general surgery department from 2016 to 2021. Total STAR and section-specific STAR scores were compared using the two independent sample Student's ttest on SPSS Statistics, version 23 (IBM Corp, Armonk, NY). RESULTS: A total of 488 records were selected and evaluated using the STAR. The total STAR scores significantly improved steadily throughout the years compared to the baseline in 2016, reaching the highest in 2021. All domains had improved compared to the baseline except for anesthesia records that did not change from an already high baseline. The highest improvements between STAR domains were observed in Initial Clerking and Consent domains. CONCLUSION: Our study demonstrates that significant improvements in the quality of surgical records can be achieved by simply using an electronic record entry system, personnel education, and systematic auditing.

Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab.

BACKGROUND: Despite the good outcomes achieved with intravitreal angiogenic therapy, a subset of neovascular age-related macular degeneration (AMD) patients experience resistance to therapy after repeated injections. Switching drugs could offer benefit to this group of patients. PURPOSE: To determine visual and anatomical outcomes in a cohort of neovascular AMD patients resistant to repeated injections of bevacizumab/ranibizumab after switching to aflibercept therapy. METHODS: This was a retrospective chart review of patients who had a diagnosis of neovascular AMD and persistent intraretinal (IRF) and/or subretinal fluid (SRF) on optical coherence tomography (OCT) for at least 3 months despite monthly bevacizumab and/or ranibizumab injections prior to transition to aflibercept. We reviewed patients' records and OCT images obtained at baseline, 1, 3, 6 and 12 months after transition to aflibercept. Data collected included demographics, best-corrected visual acuity (BCVA), number of injections received and the occurrence of any adverse events. Studied OCT parameters included central macular thickness (CMT) values and the presence or absence of SRF, IRF and/or pigment epithelial detachment (PED) at each visit. RESULTS: We included 53 eyes of 48 patients. Mean change in BCVA from baseline was 0.05 ± 0.13 (P = 0.01) at M1, 0.04 ± 0.16 (P = 0.08) at M3, 0.01 ± 0.22 (P = 0.9) at M6, and 0.02 ± 0.28 (P = 1) at M12, while the mean change in CMT from baseline was 64 ± 75 µm (P < 0.0001) at M1, 42 ± 85 µm (P = 0.002) at M3, 47 ± 69 µm (P < 0.0001) at M6, and 46 ± 99 µm (P = 0.001) at M12. The percentage of eyes with SRF decreased from 77.4% at baseline to 39.6% at M1, then increased to 47.2% at M3, then decreased to 43.4% at M6, and to 41.5% at M12 (All p < 0.001, compared to baseline). Compared to baseline, there was a statistically significant decrease in the percentage of eyes having IRF from 47.2 to 20.8% at M1 (p < 0.001), 30.2% at M3, 24.5% at M6 and 26.4% at M12 (p < 0.01, each). The number of bevacizumab and/or ranibizumab injections (7.36 ± 1.85) was significantly higher than that of aflibercept (6.47 ± 2.45, p = 0.001). A significant direct relationship between CMT reduction and BCVA improvement was demonstrated at M1 (p = 0.01, r = 0.36), M3 (p = 0.03, r = 0.30) and M12 (p = 0.03, r = 0.30). Eyes with IRF had significantly poorer BCVA than eyes without IRF at baseline (p = 0.02) and M3 (p = 0.04). CONCLUSION: Switching to intravitreal aflibercept therapy in a cohort of neovascular AMD patients resistant to chronic bevacizumab and/or ranibizumab injections can lead to significant visual improvement in the short term and sustained reduction of central macular thickness over 1 year of followup.

Macular Atrophy in Neovascular Age-Related Macular Degeneration with Monthly versus Treat-and-Extend Ranibizumab: Findings from the TREX-AMD Trial.

PURPOSE: To compare the enlargement rate of macular atrophy (ERMA) in eyes treated with ranibizumab monthly or using a treat-and-extend (TREX) regimen for neovascular age-related macular degeneration (AMD) or fellow control eyes, as well as analyze risk factors for macular atrophy (MA) development and progression. DESIGN: Eighteen-month, multicenter, randomized, controlled clinical trial. PARTICIPANTS: Sixty patients with treatment-naïve neovascular AMD in 1 eye randomized 1:2 to monthly or TREX ranibizumab. METHODS: Patients' study and fellow eyes were followed for 18 months using spectral-domain optical coherence tomography (SD OCT) and fundus autofluorescence (FAF) imaging. The MA was quantified on FAF images using Heidelberg Region Finder software (Heidelberg Engineering, Heidelberg, Germany), with suspected areas of atrophy confirmed by SD OCT and infrared reflectance imaging. For eyes without baseline MA yet developed MA by 18 months, intervening visits were assessed to determine the first visit at which MA appeared to define progression rates. Foveal choroidal thickness (FCT), subretinal hyperreflective material (SHRM), and pigment epithelial detachment (PED), were assessed at baseline to determine whether they influenced MA progression. MAIN OUTCOME MEASURES: Mean ERMA at 18 months. Relationship between visual acuity and MA, and the baseline risk factors for ERMA were also assessed. RESULTS: The final analysis cohort included 88 eyes in 3 groups: monthly (n = 19), TREX (n = 30), and control fellow eyes (n = 39). Mean ERMA over 18 months was 0.39±0.67 (monthly), 1.1±1.9 (TREX), and 0.49±1 mm2 (control, P = 0.12). Mean ERMA per group among the 40.9% (n = 36) of baseline patients with MA was 0.9±1, 1.9±2.2, and 1±1.3 mm2, respectively (P = 0.31). The incidence rate of MA in the 3 groups was 40%, 0%, and 8.3%, respectively. Mann-Whitney U test revealed a statistically significant association between baseline FCT (127±46 vs. 155±55 µm, P = 0.01) and SHRM thickness (106±131 vs. 50±85 µm, P = 0.02) on MA. In eyes with no baseline MA, presence of SHRM, SHRM, and PED thickness, and presence of baseline hemorrhage were all significant predictors of new MA development (P = 0.04, 0.01, 0.04, 0.004, 0.01, respectively). CONCLUSIONS: Ranibizumab did not show a statistically significant influence on new MA development in eyes with neovascular AMD, whether dosed monthly or per TREX regimen. The FCT, SHRM thickness, and hemorrhage at baseline were all significant predictors of new MA.

Host immune cellular reactions in corneal neovascularization.

Corneal neovascularization (CNV) is a global important cause of visual impairment. The immune mechanisms leading to corneal heme- and lymphangiogenesis have been extensively studied over the past years as more attempts were made to develop better prophylactic and therapeutic measures. This article aims to discuss immune cells of particular relevance to CNV, with a focus on macrophages, Th17 cells, dendritic cells and the underlying immunology of common pathologies involving neovascularization of the cornea. Hopefully, a thorough understanding of these topics would propel the efforts to halt the detrimental effects of CNV.

Keratoconus correction using a new model of intrastromal corneal ring segments.

PURPOSE: To evaluate the optical value of a new model of intrastromal corneal ring segments (ICRS) (Keratacx Plus) in patients with keratoconus and to quantify subsequent changes in corneal topography and asphericity. SETTING: Private practice. DESIGN: Prospective case series. METHODS: This study comprised patients who had primary keratoconus or keratectasia after laser in situ keratomileusis (LASIK); none wore contact lenses. Rings were implanted through tunnels created manually or with a femtosecond laser. All eyes had clear visual axes and corneal thickness over 450 µm at the incision site. Preoperative and postoperative pachymetry images were acquired. Results were analyzed using a matched-pair t test and the Kolmogorov-Smirnov test. RESULTS: Twenty-nine eyes (24 patients; mean age 30.1 years ± 10.6 [SD]) were evaluated. The ICRS significantly increased uncorrected and corrected visual acuities from 0.05 to 0.16 and from 0.17 to 0.5, respectively (z = 4.7, P < .001). They reduced the median spherical error from -4.0 to -0.5 diopters (D) (P < .001) and median cylindrical error from -4.4 to -2.5 D (P < .001). All topographic parameters were reduced, including maximum keratometry (K) (49.4 D versus 45.1 D), minimum K (49.4 D versus 45.1 D), mean K (51.4 D versus 48.4 D), astigmatism (-2.0 D versus -0.5 D), and asphericity (eccentricity 0.49 versus 0.23) (all P < .001). CONCLUSIONS: The ICRS provided topographic and visual improvement in keratoconus and post-LASIK keratectasia. Variance in surgical outcomes with manual versus femtosecond tunneling and the effect of different ring sizes are yet to be studied.

Does closure of the mesenteric defects during antecolic laparoscopic gastric bypass for morbid obesity reduce the incidence of symptomatic internal herniation?

A best evidence topic in surgery was written according to a structured protocol. The question asked was whether the closure of the mesenteric defects during laparoscopic gastric bypass via antecolic approach for morbid obesity reduces the incidence of symptomatic internal herniation. 251 papers were found using the reported search strategy of which three papers best represented the answer to the question. All three studies showed that by closuring the mesenteric defects, resulted in a reduction in the incidence of symptomatic internal hernias. One study showed there to be new complications arising from primary closure, but this was undetermined statistically. The evidence still however remains limited regarding the need for closure of mesenteric defects in gastric bypass operations. We recommend there is a need for large scale randomized control trials with suitable follow up for patients.

Investigation of medication prescribing errors in Wad Medani, Gezira, Sudan.

This is Sudan's first cross sectional exploratory study aimed to analyze the appropriateness of prescriptions written in different health settings in Wad Medani, Sudan. Two pretested questionnaires were used to collect information about the possible causes of medication errors from randomly selected practicing physicians and pharmacists. The sample consisted of 2000 prescriptions collected in the period of August and September 2009. There were statistically significant differences between legibility of printed and handwritten prescriptions (p < 0.001), of all prescriptions 43.8% was not accompanied by instructions to the patients and 14% contained potential interactions with different degrees of seriousness, ranging from minor 1.8%, moderate 8.4% and severe 3.9%. According to the standard classifications of prescription writing, only one prescription (0.1%) was considered ideal with no error encountered, 12.2% of prescriptions contained errors being potentially serious to the patients, 17.8% showed errors of major importance, 6.9% had errors of minor importance and 10.5% contained trivial errors. While of the prescriptions 52.6% were free from errors but they were incomplete, something that could lead to serious patients' harm. The study identified a range of weaknesses in the prescribing phase and proposed a set of recommendations encouraging physicians and pharmacists to work together to avoid such errors.

T regulatory cells, the evolution of targeted immunotherapy.

T regulatory cells are able to suppress anti-tumour immunity in pre-clinical models and in patients. This review highlights the important discoveries in Treg immunology critical to the evolution of targeted immunotherapy. We also describe the therapeutic applications that are currently being assessed and their future potential.

T-regulatory cell modulation: the future of cancer immunotherapy?

T-regulatory cells suppress anti-tumour immunity in cancer patients and in murine tumour models. Furthermore, their activity is likely to have an effect on the effectiveness of immunotherapeutic treatments for cancer. Here we describe the current status of developing clinical strategies for modulating Treg activity in cancer patients.

Ethyl 6-methyl-2-oxo-4-phenyl-1,2,3,4-tetra-hydro-pyrimidine-5-carboxyl-ate.

The title compound, C(14)H(16)N(2)O(3), belongs to a group of esters of 2-oxo- and 1,2,3,4-tetra-hydro-pyrimidine-5-carboxylic acids, which exhibit a wide spectrum of biological activities. The dihydro-pyrimidine ring adopts a screw-boat conformation. The crystal packing is stabilized by strong N-H⋯O and weak C-H⋯O inter-molecular hydrogen bonds. An intra-molecular C-H⋯O hydrogen bond is also present.