Developing and Validating a Tool to Assess Telemedicine Acceptance Among Physicians During Pandemic Using a Technology Acceptance Model.

Background: The World health organization declared the coronavirus outbreak a global pandemic on March 11, 2020. Telemedicine was one of the effective tools that were implemented during this pandemic. Most Lebanese physicians have been using telemedicine to perform virtual medical services during the COVID-19 pandemic. Therefore, it is important to assess the physicians' acceptability of telemedicine and willingness to use it in routine health care settings. Objective: We developed and validated a tool based on technology acceptance model (TAM) to explore the acceptance of telemedicine use during the pandemic among Lebanese physicians. Theoretical Background: Telemedicine Acceptance Model during Pandemic (TeAM) was developed based on TAM. The model was developed considering the associations between constructs affecting the physicians' attitudes about telemedicine use. TeAM is a tool assessing telemedicine acceptance based on the TAM. It has additional constructs tackling the perceived risks of telemedicine use, the perceived need for policies, the perceived need for training, and the perceived usefulness of telemedicine during a pandemic. Methods: This cross-sectional study was conducted online through an email-based questionnaire sent to physicians enrolled in the Lebanese Order of Physicians. Results: Three hundred ninety physicians (n = 390) completed the survey. The tool was structured to test 10 hypotheses, out of which 9 were supported. The Cronbach's alpha score of each construct ranged between 0.745 and 0.905, all greater than 0.7 indicating an acceptable to excellent internal consistency. Conclusion: This study was able to validate TeAM as a reliable tool that can assess the acceptance of telemedicine among physicians. Accordingly, several determinants influencing this acceptance were identified. Practice implications include hospitals, primary health care centers, and national health care systems willing to adopt telemedicine can use TeAM to assess the physicians' willingness to accept the implementation of telemedicine in their practice.

Utilization of Telemedicine by the Lebanese Physicians During Time of Pandemic.

Introduction: The use of technology in the medical field has been rising rapidly and offering, in many cases, an alternative to traditional ways of practicing medicine, especially when remote medical services are required. This background has laid the foundation for telemedicine to play a role in controlling the current coronavirus disease 2019 (COVID-19) pandemic. Telemedicine has the potential to allow the facilitation of providing the necessary medical care to patients without exposing them to contact with other patients or the general population. Objective: The aim of this study was to investigate the utilization of telemedicine by the Lebanese physicians during the COVID-19 pandemic. Methods: This cross-sectional online study was conducted using LimeSurvey® through an e-mail-based questionnaire sent to physicians currently enrolled in both Beirut and Tripoli Lebanese Order of Physicians. Results: Four hundred one physicians completed the survey resulting in a response rate of 5.85%. Most of the respondents (N = 401, 75.8%) reported using telemedicine to provide health care services to patients without in-person visits during the pandemic. Among those using telemedicine (N = 304), around 40% reported that they started using it during COVID-19 pandemic. Discussion: Literature states that the average time of an in-person clinic consultation is more than 15 min. This implies that telemedicine can play a role in saving physicians' time; this conclusion is supported by other studies that consider telemedicine a time-saving method of providing health care services. Conclusions: Our study indicated that telemedicine is used by the majority of Lebanese physicians and that this use has been accelerated by the COVID-19 pandemic. Our results showed that telemedicine does have a potential that can allow it to be integrated in the health care system and implemented on a national organized level.

Synthesis, Characterization, Antimicrobial Activity, and Genotoxicity Assessment of Two Heterocyclic Compounds Containing 1,2,3-Selena- or 1,2,3-Thiadiazole Rings.

New 1,2,3-thiadiazole and 1,2,3-selenadiazole derivatives, (4-[4-((4-bromobenzyl)oxy)-phenyl]-1,2,3-thiadiazole (5a), 4-[4-((4-chlorobenzyl)oxy)-phenyl]-1,2,3-thiadiazole (5b)), (4-[4-((4-bromobenzyl)oxy)-phenyl]-1,2,3-selenadiazole (6a), and 4-[4-((4-chlorobenzyl)oxy)-phenyl]-1,2,3-selenadiazole (6b)), were prepared and screened in vitro for their antimicrobial activity against various pathogenic microbes. In addition, two compounds (5a and 6a) were examined for their in vivo genotoxicity using rats and an 8-hydroxy-2'-deoxyguanosine (8-OHdG) assay. Compounds 5a and 5b were found to be highly active against Gram-positive and Gram-negative bacteria. In addition, a significant inhibition of urinary 8-OHdG level (50.2%) was observed upon treatment of animals with 500 mg/kg body weight (b.w.) of compound 6a (p < 0.0001). However, compound 5a increased urinary 8-OHdG levels. The lethal dose (LD50) values for compounds 5a and 6a were determined by an up-and-down procedure (OECD 425; OECD 1998), which showed that these compounds are safe, since the LD50 was >5000 mg/kg b.w. Thus, the tested compounds might have the potential for use as antibiotics, since they have low genotoxicity and strong antimicrobial activity.

Clinical Significance of Evaluation of Monocytic Receptors in Patients with Hepatitis C Virus Infection.

Monocytes in hepatitis C virus (HCV) infection play a critical role in chronic liver inflammation and fibrosis. We studied circulating monocytes and monocyte receptors in patients with HCV infection who were naive to treatment and those who received direct acting antiviral therapy and achieved sustained virological response. CD64+ CCR2+ (M1-like) and CD206+ CD163+ CX3CR1+ (M2-like) monocyte numbers and receptor expression were evaluated by flow cytometry. Higher expression of the monocyte chemokine receptor CCR2 predicted the severity of liver fibrosis, independent of successful treatment and viral clearance (R2 = 0.235, p = 0.002), whereas monocyte CX3CR1 expression was lower in both treated and untreated patients compared with controls (p = 0.011). The expression of the scavenger receptor CD163 was lower in patients with successful treatment (p = 0.005), supporting its role as a marker of treatment response. CD64+ CCR2+ (M1-like) and CD206+ CD163+ CX3CR1+ (M2-like) monocyte numbers were not altered with fibrosis progression or treatment response. Our findings reflect the diverse functions of monocytes in liver inflammation, fibrosis, and therapy. However, HCV clearance did not lead to complete monocyte reconstitution. Targeting monocytes and their chemokine receptors bears therapeutic potential to reduce liver fibrosis and improve disease outcome.

In Silico and In Vitro Evaluation of Some Amidine Derivatives as Hit Compounds towards Development of Inhibitors against Coronavirus Diseases.

Coronaviruses, including SARS-CoV-2, SARS-CoV, MERS-CoV and influenza A virus, require the host proteases to mediate viral entry into cells. Rather than targeting the continuously mutating viral proteins, targeting the conserved host-based entry mechanism could offer advantages. Nafamostat and camostat were discovered as covalent inhibitors of TMPRSS2 protease involved in viral entry. To circumvent their limitations, a reversible inhibitor might be required. Considering nafamostat structure and using pentamidine as a starting point, a small set of structurally diverse rigid analogues were designed and evaluated in silico to guide selection of compounds to be prepared for biological evaluation. Based on the results of in silico study, six compounds were prepared and evaluated in vitro. At the enzyme level, compounds 10-12 triggered potential TMPRSS2 inhibition with low micromolar IC50 concentrations, but they were less effective in cellular assays. Meanwhile, compound 14 did not trigger potential TMPRSS2 inhibition at the enzyme level, but it showed potential cellular activity regarding inhibition of membrane fusion with a low micromolar IC50 value of 10.87 µM, suggesting its action could be mediated by another molecular target. Furthermore, in vitro evaluation showed that compound 14 inhibited pseudovirus entry as well as thrombin and factor Xa. Together, this study presents compound 14 as a hit compound that might serve as a starting point for developing potential viral entry inhibitors with possible application against coronaviruses.

Treatment of multidrug-resistant Pseudomonas aeruginosa bacteremia using ceftolozane-tazobactam-based or colistin-based antibiotic regimens: A multicenter retrospective study.

BACKGROUND: Ceftolozane-tazobactam is an emerging treatment for severe infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa. However, limited data support its use in bacteremia treatment. This study aimed to assess the effectiveness of the treatment of MDR P. aeruginosa bacteremia using ceftolozane- tazobactam-based or colistin-based regimens. PATIENTS AND METHODS: This retrospective, cohort, multicentre study included adult patients with MDR P. aeruginosa bacteremia treated with either ceftolozane-tazobactam or colistin, between September 2018 and August 2021, at four hospitals in Saudi Arabia. The primary endpoint was the 30-day risk-adjusted mortality. Secondary endpoints included the 14-day risk of mortality, bacterial eradication, and clinical success. Cox proportional hazards regression and relative risk estimation were used for analysis, as appropriate. RESULTS: In total, 46 patients were included; 17 patients received ceftolozane- tazobactam-based regimen, and 29 received a colistin-based regimen. There was no association with the use of ceftolozane-tazobactam compared to colistin and the 30-day risk-adjusted mortality (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.16-2.13, P = 0.42). Also, the 14-day risk of mortality and bacterial eradication were not different between the ceftolozane-tazobactam and colistin regimens, HR 2.1, 95% CI 0.42-10.48; P = 0.36; and relative risk (RR) 0.65; 95% CI 0.28-1.52; P = 0.30; respectively. On the other hand, ceftolozane-tazobactam use was associated with higher clinical success than colistin (RR 1.84, 95% CI 1.11-3.06: P = 0.021). CONCLUSION: The risk of mortality of MDR P.aeruginosa bacteremia was similar when treated with ceftolozane-tazobactam-based or colistin-based antimicrobial regimens. A higher clinical success was observed with the ceftolozane- tazobactam-based regimen compared to the colistin-based regimen. .

Does nephrotoxicity develop less frequently when vancomycin is combined with imipenem-cilastatin than with meropenem? A comparative study.

Introduction: Nephrotoxicity is a frequent complication of vancomycin therapy. Experimental studies in different animal species have demonstrated the attenuation of vancomycin-associated nephrotoxicity with cilastatin administration. This study aimed to evaluate if imipenem-cilastatin attenuates vancomycin-associated nephrotoxicity, in patients treated with combinations of vancomycin and carbapenems. Methods: This retrospective, propensity-score matched study was conducted at King Faisal Specialist Hospital and Research Centre, Riyadh and Jeddah. Nephrotoxicity was compared in patients who received imipenem-cilastatin + vancomycin or meropenem + vancomycin. Patients with no history of renal disease who received imipenem-cilastatin + vancomycin or meropenem + vancomycin for a minimum of 72 h, from 1 January 2017 to 31 December 2017, were included. Nephrotoxicity was defined according to the RIFLE criteria (Risk, Injury, Failure, Loss, End-stage renal disease) if sustained for least 72 h. Results: A total of 227 patients were included in the analysis, consisting of 121 patients in the imipenem-cilastatin + vancomycin group, and 106 patients in the meropenem + vancomycin group. In the unmatched data set the rate of nephrotoxicity was 8.2% in imipenem-cilastatin + vancomycin group and 20.7% in the meropenem + vancomycin group (p = .007). Logistic regression analysis showed that imipenem-cilastatin + vancomycin therapy was associated with a 56% lower rate of nephrotoxicity compared to meropenem + vancomycin therapy. Propensity-score matching resulted in rates of nephrotoxicity of 6.2% and 17.1% in the imipenem-cilastatin + vancomycin group and the meropenem + vancomycin groups, respectively (p = .034). Conclusion: Vancomycin-associated nephrotoxicity developed less frequently when vancomycin was combined with imipenem-cilastatin than when combined with meropenem.