COMPLIANCE AND CHALLENGES OF TRANSMISSION BASED PRECAUTION PRACTICES AMONG NURSES IN JORDANIAN HOSPITALS DURING THE NOVEL COVID-19: A DESCRIPTIVE STUDY.

Standard precautions practices are crucial management skills among nurses against the highly infectious novel COVID-19. The study aimed to investigate the level of nurses' compliance infected with standard precautions, and identify the main challenges experienced by nurses during their work with COVID-19 patients. A cross-sectional survey design was used. The study was done at the beginning of the pandemic in public and private hospitals in Jordan. About 386 front-line nurses filled out the online questionnaire. Most of the participants revealed dealing with COVID-19 patients (73.6%). Generally, nurses demonstrated a good level of compliance with standard practices (71%). The staff reported that they mostly adhere to performing hand hygiene after all procedures (65.8%). On the other hand, they were the least adherence to maintaining a physical distance of patients and staff of at least 6 feet apart (28.5%). Strict observation of the compliance of nurses with the standard precautions practices is crucial to be maintained at the highest level to eliminate the spreading of COVID-19 among other community members. More efforts should be come to light including continuous training and education sessions to enhance nurses' level of knowledge and practice concerning controlling the outbreak of the novel pandemic.

RS 2247911 polymorphism of GPRC6A gene and serum undercarboxylated-osteocalcin are associated with testis function.

PURPOSE: Undercarboxylated-Osteocalcin (ucOCN), acting on its putative receptor GPRC6A, was shown to stimulate testosterone (T) production by Leydig cells in rodents, in parallel with the hypothalamus-pituitary-gonadal axis (HPG) mediated by luteinizing hormone (LH). The aim of this cross-sectional study was to evaluate the association among serum ucOCN, rs2247911 polymorphism of GPRC6A gene and the endocrine/semen pattern in a cohort of infertile males, possibly identifying an involvement of the ucOCN-GPRC6A axis on testis function. METHODS: 190 males, including 74 oligozoospermic subjects, 58 azoosperminc patients and 58 normozoospermic controls, were prospectively recruited at the Orient Hospital for Infertility, Assisted Reproduction and Genetics in Syria (Study N. 18FP), from July 2018 to June 2020. Outpatient evaluation included the clinical history, anthropometrics and a fasting blood sampling for hormonals, serum OCN (both carboxylated and undercarboxylated), glycemic and lipid profile and screening for rs2247911 GPRC6A gene polymorphism. RESULTS: Higher serum ucOCN associated with higher T and HDL-cholesterol (respectively: r = 0.309, P < 0.001 and r = 0.248, P = 0.001), and with lower FSH (r = - 0.327, P < 0.001) and LDL-cholesterol (r = - 0.171; P = 0.018). Patients bearing the GG genotype of rs2247911 had higher sperm count compared to GA genotype (P = 0.043) and, compared to both AG and AA genotypes, had higher serum T (P = 0.004, P = 0.001) and lower triglycerides levels (P = 0.002, P < 0.001). Upon normalization for LH levels and body mass index, rs2274911 and ucOCN were significantly associated with higher serum T at linear stepwise regression analysis (P = 0.013, P = 0.007). CONCLUSIONS: Our data suggest the involvement of ucOCN-GPRC6A axis in the regulation of T production by the testis, subsidiary to HPG.

A mild ovarian stimulation strategy in women with poor ovarian reserve undergoing IVF: a multicenter randomized non-inferiority trial.

STUDY QUESTION: In subfertile women with poor ovarian reserve undergoing IVF does a mild ovarian stimulation strategy lead to comparable ongoing pregnancy rates in comparison to a conventional ovarian stimulation strategy? SUMMARY ANSWER: A mild ovarian stimulation strategy in women with poor ovarian reserve undergoing IVF leads to similar ongoing pregnancy rates as a conventional ovarian stimulation strategy. WHAT IS KNOWN ALREADY: Women diagnosed with poor ovarian reserve are treated with a conventional ovarian stimulation strategy consisting of high-dose gonadotropins and pituitary downregulation with a long mid-luteal start GnRH-agonist protocol. Previous studies comparing a conventional strategy with a mild ovarian stimulation strategy consisting of low-dose gonadotropins and pituitary downregulation with a GnRH-antagonist have been under powered and their effectiveness is inconclusive. STUDY DESIGN, SIZE, DURATION: This open label multicenter randomized trial was designed to compare one cycle of a mild ovarian stimulation strategy consisting of low-dose gonadotropins (150 IU FSH) and pituitary downregulation with a GnRH-antagonist to one cycle of a conventional ovarian stimulation strategy consisting of high-dose gonadotropins (450 IU HMG) and pituitary downregulation with a long mid-luteal GnRH-agonist in women of advanced maternal age and/or women with poor ovarian reserve undergoing IVF between May 2011 and April 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS: Couples seeking infertility treatment were eligible if they fulfilled the following inclusion criteria: female age ≥35 years, a raised basal FSH level >10 IU/ml irrespective of age, a low antral follicular count of ≤5 follicles or poor ovarian response or cycle cancellation during a previous IVF cycle irrespective of age. The primary outcome was ongoing pregnancy rate per woman randomized. Analyses were on an intention-to-treat basis. We randomly assigned 195 women to the mild ovarian stimulation strategy and 199 women to the conventional ovarian stimulation strategy. MAIN RESULTS AND THE ROLE OF CHANCE: Ongoing pregnancy rate was 12.8% (25/195) for mild ovarian stimulation versus 13.6% (27/199) for conventional ovarian stimulation leading to a risk ratio of 0.95 (95% CI: 0.57-1.57), representing an absolute difference of -0.7% (95% CI: -7.4 to 5.9). This 95% CI does not extend below the predefined threshold of 10% for inferiority. The duration of ovarian stimulation was significantly lower in the mild ovarian stimulation strategy than in the conventional ovarian stimulation strategy (mean difference -1.2 days, 95% CI: -1.88 to -0.62). Also, a significantly lower amount of gonadotropins was used in the mild simulation strategy, with a mean difference of 3135 IU (95% CI: -3331 to -2940). LIMITATIONS, REASONS FOR CAUTION: A limitation of our study was the lack of data concerning the cryopreservation of surplus embryos, so we are not informed on cumulative pregnancy rates. Another limitation is that we were not able to follow up on the ongoing pregnancies in all centers, so we are not informed on live birth rates. WIDER IMPLICATIONS OF THE FINDINGS: The results are directly applicable in daily clinical practice and may lead to considerable cost savings as high dosages of gonadotropins are not necessary in women with poor ovarian reserve undergoing IVF. A health economic analysis of our data planned to test the hypothesis that mild ovarian stimulation strategy is more cost-effective than the conventional ovarian stimulation strategy is underway. STUDY FUNDING/COMPETING INTERESTS: This study was supported by NUFFIC scholarship (the Netherlands) and STDF short-term fellowship (Egypt). TRIAL REGISTRATION NUMBER: NTR2788 (Trialregister.nl). TRIAL REGISTER DATE: 01 March 2011. DATE OF FIRST PATIENT'S ENROLMENT: May 2011.

Precise higher-order reflectivity and morphology models for early diagnosis of diabetic retinopathy using OCT images.

This study proposes a novel computer assisted diagnostic (CAD) system for early diagnosis of diabetic retinopathy (DR) using optical coherence tomography (OCT) B-scans. The CAD system is based on fusing novel OCT markers that describe both the morphology/anatomy and the reflectivity of retinal layers to improve DR diagnosis. This system separates retinal layers automatically using a segmentation approach based on an adaptive appearance and their prior shape information. High-order morphological and novel reflectivity markers are extracted from individual segmented layers. Namely, the morphological markers are layer thickness and tortuosity while the reflectivity markers are the 1st-order reflectivity of the layer in addition to local and global high-order reflectivity based on Markov-Gibbs random field (MGRF) and gray-level co-occurrence matrix (GLCM), respectively. The extracted image-derived markers are represented using cumulative distribution function (CDF) descriptors. The constructed CDFs are then described using their statistical measures, i.e., the 10th through 90th percentiles with a 10% increment. For individual layer classification, each extracted descriptor of a given layer is fed to a support vector machine (SVM) classifier with a linear kernel. The results of the four classifiers are then fused using a backpropagation neural network (BNN) to diagnose each retinal layer. For global subject diagnosis, classification outputs (probabilities) of the twelve layers are fused using another BNN to make the final diagnosis of the B-scan. This system is validated and tested on 130 patients, with two scans for both eyes (i.e. 260 OCT images), with a balanced number of normal and DR subjects using different validation metrics: 2-folds, 4-folds, 10-folds, and leave-one-subject-out (LOSO) cross-validation approaches. The performance of the proposed system was evaluated using sensitivity, specificity, F1-score, and accuracy metrics. The system's performance after the fusion of these different markers showed better performance compared with individual markers and other machine learning fusion methods. Namely, it achieved [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text], respectively, using the LOSO cross-validation technique. The reported results, based on the integration of morphology and reflectivity markers and by using state-of-the-art machine learning classifications, demonstrate the ability of the proposed system to diagnose the DR early.

Cauda Equina Syndrome Secondary to Leptomeningeal Carcinomatosis of Gastroesophageal Junction Cancer.

Leptomeningeal carcinomatosis (LMC) is a diffuse or multifocal malignant infiltration of the pia matter and arachnoid membrane. The most commonly reported cancers associated with LMC are breast, lung, and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. We report a case of LMC secondary to gastroesopha-geal junction cancer present initially with cauda equina syndrome. A 51-year-old male patient with treated adenocarcinoma of the gastroesophageal junction presented with left leg pain, mild weakness, and saddle area numbness. Initial radiological examinations were unremarkable. Subsequently, he had worsening of his leg weakness, fecal incontinence, and urine retention. Two days later, he developed rapidly progressive cranial neuropathies including facial diplegia, sensorineural hearing loss, dysarthria, and dysphagia. MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord, and cauda equina extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. The patient died within 10 days from the second presentation. In cancer patients with cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered. To our knowledge, this is the first case of LMC secondary to gastroesophageal cancer presenting with cauda equina syndrome.

The human and simian immunodeficiency viruses HIV-1, HIV-2 and SIV interact with similar epitopes on their cellular receptor, the CD4 molecule.

The cellular receptor for HIV-1 is the leucocyte differentiation antigen, CD4. Blocking of HIV-1 infectivity can be achieved with monoclonal antibodies (MAbs) to some, but not all epitopes of this antigen. We demonstrate here, by inhibition of virus infection, blocking of syncytium formation and inhibition of pseudotype infection with a panel of CD4 MAbs, that HIV-1, HIV-2 and simian immunodeficiency virus (SIV) isolates share the same cellular receptor, the CD4 glycoprotein. It is also shown that very similar epitopes of this molecule are involved in virus binding. We infer from these data that the binding sites on these viruses are highly conserved regions, and may therefore make good targets for potential vaccines. In addition, we show that cell surface expression of CD4 is similarly modulated after infection of cell lines by all the viruses.

Serial angiography in isolated angiitis of the central nervous system.

Isolated angiitis of the CNS is a disease of unknown etiology characterized by signs and symptoms of diffuse ischemia or recurrent strokes and histologic evidence of vascular inflammation. Angiography frequently suggests the diagnosis, but angiographic changes over time have not been delineated. This study investigates the evolution of radiographic findings in CNS vasculitis by serial angiography in 19 patients. Abnormal angiographic findings include segmental arterial narrowings and dilatations, vascular occlusions, collateral formation, and prolonged circulation time. Smooth narrowings of the affected vessels occurring in multiple vascular distributions are the most frequent abnormality. Single stenotic areas in multiple vessels are more frequent than multiple stenotic areas along a single vessel segment. Vascular occlusions, the least diagnostic feature, affect small arteries in some patients. Serial studies demonstrate progression of angiographic changes prior to therapy and improvement or stabilization in patients with a clinical response to therapy. Correlation of clinical and angiographic features is consistent with the hypothesis that segmental narrowing initially results from reversible inflammation and vasospasm. The later irreversible angiographic features appear secondary to scarring. A limitation of angiography is demonstrated in this study by the apparently normal angiograms in two patients with biopsy-confirmed small-vessel vasculitis. Four patients with abnormal angiograms and histologic evidence of disease had normal MRIs.

Anabolic steroids induce injury and apoptosis of differentiated skeletal muscle.

Apoptosis is an active form of cellular death, or suicide, which plays an important physiologic role during organ development and in cellular turnover in differentiated tissues. Apoptosis has also been demonstrated to occur in several organs in response to hypoxic/ischemic, oxidative, or drug-induced injury and is thus involved in disease pathogenesis. However, it is generally assumed that apoptosis does not occur in differentiated skeletal muscle. Apoptosis has been demonstrated in differentiated myocardial muscle, neonatal skeletal muscle, and skeletal myoblasts in response to injury. We therefore studied differentiated murine C2 skeletal muscle cells that have been injured by supraphysiologic doses (>10 microM) of an anabolic steroid, stanozolol. Stanozolol-injured muscle cells exhibited pathologic features suggestive of apoptosis: cytoplasmic shrinkage and chromatin condensation. Muscle cells also showed positive in situ nick-end labeling of nuclear chromatin, indicating DNA strand breakage. Staining with the DNA-binding dye 33342 (bisbenzimide) also showed chromatin changes characteristic of apoptotic nuclei. Total protein levels measured at 4 and 24 hr post-stanozolol injury was not significantly decreased, indicating absence of cell lysis. Cellular ATP levels (nmol ATP/mg protein) of stanozolol-injured muscle cells, measured 4 and 24 hr postinjury, also did not change significantly. In contrast, necrotic muscle cells, injured by the calcium ionophore A23187 (2 microM), showed a progressive decline in total protein and ATP levels. This study supports two other histologic studies that showed evidence of apoptosis in differentiated skeletal muscle fibers. Our data further suggest that during the early stages of apoptosis, but not necrosis, cellular energy metabolism is preserved.