bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of the efficacy of a fatigue management therapy in schizophrenia: study protocol for a randomized, controlled multi-centered study (ENERGY)
Authors: Raffard Stéphane , Rainteau Nicolas , Bayard Sophie , Laraki Yasmine , Norton Joanna , Capdevielle Delphine
Published: July 2020

Background Fatigue is a well-known common clinical feature of numerous chronic diseases including various forms of cancer, neurological disorders such as multiple sclerosis, and psychiatric disorders. A significant proportion of people with schizophrenia (30-60%) reportedly experience fatigue, which impacts negatively on participation in various activities, including work, study, leisure and social pursuits. Causes of fatigue in schizophrenia are poorly understood and there are no established treatments. Several evidence-based interventions for fatigue syndrome including psychoeducation, cognitive behavioral therapy, and graded exercise therapy have been shown to be effective in other medical conditions and could be adapted to address fatigue in schizophrenia patients. As there are no psychosocial or pharmacological interventions with proved efficacy for fatigue in schizophrenia, there is an urgent need for the development of strategies to improve fatigue management in schizophrenia.The aim of this project is to evaluate in a single blind randomized clinical trial the efficacy of a cognitive-behavioral therapy (CBT) intervention compared to treatment as usual (TAU) on fatigue as the main outcome in schizophrenia patients. Clinical symptoms, physical functioning, major cognitive functions, quality of life and functioning, treatment dosage, daily motor activity, biological markers with inflammatory markers are also considered as secondary outcomes. Methods/design 200 patients meeting the inclusion criteria will be randomized to either of the study arms (intervention or TAU). The ENERGY intervention will be delivered according to a standardized treatment manual comprising six modules addressing fatigue and sleep over 14 individual therapy sessions. The treatment encompasses core CBT principles of psycho-education, behavioral activation, behavioral experiments, cognitive restructuring, problem-solving and relapse prevention. Sessions will follow the traditional CBT structure of agenda setting, review of homework tasks, and introduction of a new concept/technique with collaborative discussions on how to implement such strategies in the participant’s day-to-day environment. Our primary endpoint will be the severity of fatigue assessed at baseline and at the 9-month follow-up using the “Multidimensional Fatigue Inventory” (MFI).Discussion The trial will provide the first test of CBT intervention for fatigue for patients with schizophrenia. This study will also test to what extent the treatment can be implemented in everyday practice.Trial Registration : ClinicalTrials.gov Identifier: NCT04332601. Registered on April 10, 2020
UGT1A1 polymorphism has a prognostic effect in patients with stage IB or II uterine cervical cancer and one or no metastatic pelvic nodes receiving irinotecan chemotherapy
Authors: Matsuoka Hideki , Murakami Ryusuke , Abiko Kaoru , Yamaguchi Ken , Horie Akihito , Hamanishi Junzo , Baba Tsukasa , Mandai Masaki
Published: July 2020

Background: Uridine diphosphate glucuronosyltransferase 1 family polypeptide A1 (UGT1A1) is a predictive biomarker for the side-effects of irinotecan; irinotecan chemotherapy reduces the volume of tumors harboring UGT1A1 polymorphisms. We aimed to determine whether UGT1A1 polymorphisms can predict progression-free survival in patients with local cervical cancer treated with irinotecan. Methods: We retrospectively analyzed the data of 51 patients with cervical cancer treated at a single institution between 2010 and 2015. All patients were diagnosed with the 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IB1, IB2, IIA, or IIB squamous cell carcinoma, underwent radical hysterectomy, and received irinotecan chemotherapy as neoadjuvant and/or adjuvant treatment. All patients were examined for irinotecan side effects using UGT1A1 tests. Conditional inference tree and survival analyses were performed considering stage, age, UGT1A1 status, and the number of metastatic lymph nodes to determine primary factors associated with progression-free survival.Results: The tree-structured survival model determined high recurrence-risk factors related to progression-free survival. The most relevant factor was ≥2 metastatic lymph nodes (p = 0.004). The second most relevant was UGT1A1 genotype (p = 0.024). Among patients with ≤1 metastatic lymph node, those with UGT1A1 polymorphisms benefited from irinotecan chemotherapy and demonstrated significantly longer progression-free survival (p = 0.020) than those with wild-type UGT1A1.Conclusion: Irinotecan chemotherapy has the potential to benefit patients with cervical cancer, UGT1A1 polymorphism, and ≤1 metastatic lymph nodes.
Rat epidermal stem cells promote the angiogenesis of full-thickness wound
Authors: Huang Shaobin , Hu Zhicheng , Wang Peng , zhang Yi , Cao Xiaoling , Dong Yunxian , Cheng Pu , Xu Hailin , Zhu Wenkai , Tang Bing , Zhu Jiayuan
Published: July 2020

Background: Full-thickness wounds severely affect patients’ life quality and become challenging problems for clinicians. Stem cells have great prospects in the treatment of wounds. Our previous study confirmed that autologous basal cell suspension could promote wound healing, and epidermal stem cells (ESCs) were detected in the basal cell suspension. Herein, this study aimed to explore the effect of ESCs on full-thickness wounds. Methods: Rat ESCs were isolated and expanded, and then were transfected with lentivirus to stably express enhanced green fluorescent protein. The experimental rats were randomly divided into 2 groups: in the ESC group, the rat ESCs were sprayed on the full-thickness wounds of rats; in the control group, phosphate-buffered saline was sprayed the on the wounds. Next, wound healing and neovascularization were evaluated. Colonization, division and differentiation of ESCs on the wound were analyzed by immunofluorescence. Results: The rat ESCs colonized, divided and proliferated in the wound. Additionally, rat ESCs around blood vessels differentiated into vascular endothelial cells and formed a lumen-like structure. Compared with the control group, the ESC group showed enhanced angiogenesis and accelerated wound healing. Conclusions: Our study confirmed that rat ESCs are safe and effective for treating full-thickness wounds . Additionally, under certain conditions, ESCs can differentiate into vascular endothelial cells to promote angiogenesis and wound healing.
A Health Care Professionals Training Needs Assessment for Oncology in Uganda
Authors: Byamugisha Josaphat , Munabi Ian G , Mubuuke Aloysius G. , Mwaka Amos D. , Kagawa Mike , Okullo Isaac , Niyonzima Nixon , Lusiba Pastan , Ainembabazi Peruth , Kankunda Caroline , Muhumuza Dennis D. , Orem Jackson , Atwine Diana , Ibingira Charles
Published: July 2020

Background Cancer incidence and mortality in sub-Saharan Africa are increasing and do account for significant premature death. The expertise of the health care providers is critical to down staging cancer at diagnosis and improving survival in low- and middle-income countries. We set out to determine the training needs of health care providers for a comprehensive oncology services package in selected hospitals in Uganda, in order to inform capacity development intervention to improve cancer outcomes in the East African region. Methods This was a cross-sectional survey using the WHO Hennessey-Hicks questionnaire to identify the training needs of health workers involved in cancer care, across 22 hospitals in Uganda. Data were captured in real time using the open data kit platform from which the data was exported to Stata Version 15 for analysis using the Wilcoxon sign rank test and Somers-Delta. Results There were 199 respondent health professionals who were predominately female (146/199, 73.37%), with an average age of 38.97 years. There were 158/199 (79.40%) nurses, 24/199 (12.06%) medical doctors and 17/199 (8.54%) allied health professionals. Overall the research and audit domain had the highest ranking for all the health workers (Somers-D=0.60). The respondent’s level of education had a significant effect on the observed ranking (P-value =0.03). Most of the continuing medical education (CME) topic suggested by the participants were in the clinical task related category. Conclusion The “research and audit” domain was identified as the priority area for training interventions to improve oncology services in Uganda. There are opportunities for addressing the identified training needs with an expanded cancer CME program content, peer support networks and tailored training for the individual health care provider.
Analysis of 4 imaging features in patients with COVID-19
Authors: JIN JUN , Gao De-hong , Mo Xin , Tan Si-ping , Kou Zhen-xia , Chen Yi-bo , Cao Jin-bo , Chen Wen-jing , Zhang Ya-ming , Li Bing-qing , Huang Kuan-long , Xu Bing-ren , Tang Xiao-li , Wang Yu-li
Published: July 2020

Background: The aim of this was to analyze 4 chest CT imaging features of patients with coronavirus disease 2019 (COVID-19) in Shenzhen, China so as to improve the diagnosis of COVID-19.Methods: Chest CT of 34 patients with COVID-19 confirmed by the nucleic acid test (NAT) were retrospectively analyzed. Analyses were performed to investigate the pathological basis of four imaging features(“feather sign”,“dandelion sign”,“pomegranate sign”, and “rime sign”) and to summarize the follow-up results.Results: There were 22 patients (65.2 %) with typical “feather sign”and 18 (52.9%) with “dandelion sign”, while few patients had “pomegranate sign” and “rime sign”. The “feather sign” and “dandelion sign” were composed of stripe or round ground-glass opacity(GGO), thickened blood vessels, and small-thickened interlobular septa. The “pomegranate sign” was characterized as follows: the increased range of GGO, the significant thickening of the interlobular septum, complicated with a small amount of punctate alveolar hemorrhage. The “rime sign” was characterized by numerous alveolar edemas. Microscopically, the wall thickening, small vascular proliferation, luminal stenosis, and occlusion, accompanied by interstitial infiltration of inflammatory cells, as well as numerous pulmonary interstitial fibrosis and partial hyaline degeneration were observed. Repeated chest CT revealed the mediastinal lymphadenectasis in one patient. Re-examination of the NAT showed another positive anal swab in two patients.Conclusion: “Feather sign” and “dandelion sign” were typical chest CT features in patients withCOVID-19; “pomegranate sign” was an atypical feature, and “rime sign” was a severe feature. In clinical work, accurate identification of various chest CT signs can help to improve the diagnostic accuracy of COVID-19 and reduce the misdiagnosis or missed diagnosis rate.
ANGPTL4 Overexpression Inhibits Tumor Cell Adhesion and Migration and Predicts Favorable Prognosis of Triple-Negative Breast Cancer
Authors: Cai Yu-Chen , Yang Hang , Wang Ke-Feng , Chen Tan-Huan , Jiang Wen-Qi , Shi Yan-Xia
Published: July 2020

Background: Triple-negative breast cancer (TNBC) patients have relatively poor clinical outcomes. A marker predicting the prognosis of patients with TNBC could help guide treatment. Extensive evidence demonstrates that angiopoietin-like 4 (ANGPTL4) is involved in the regulation of cancer growth, metastasis and angiogenesis. Therefore, its role in TNBC is of interest.Methods: We tested the ANGPTL4 expression level in tumor tissues by immunohistochemistry (IHC) and detected its association with the clinical features of TNBC patients. Next, the effects and mechanisms of ANGPTL4 on TNBC cell migration and adhesion were investigated.Results: We found that ANGPTL4 overexpression was associated with favorable outcomes in TNBC patients. ANGPTL4 upregulation inhibited cell adhesion, migration and invasion in vitro. Further analyses demonstrated that the possible mechanism might involve suppression of TNBC progression by interacting with extracellular matrix-related genes.Conclusions: The present findings demonstrated that enhancement of ANGPTL4 expression might inversely correlate with TNBC progression. ANGPTL4 is a promising marker of TNBC and should be evaluated in further studies. Trial registration: Retrospectively registered.
Active Learning of Medical Students in Taiwan: Arealist Evaluation
Authors: Huang Chien-Da , Tseng Hsu-Min , Jenq Chang-Chyi , Ou Liang-Shiou
Published: July 2020

BackgroundActive learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why.MethodsForty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the ‘context-mechanism-outcome’ (CMO) configurations.ResultsThree core CMO configurations including cultural, training and individual domains were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome), daring not to share their opinions. In the training context of teacher-student familiarity alongside teachers’ guidance, the mechanisms of learning motivation, self-regulation and enthusiasm are triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress, resulted in recognised active learning and advanced preparation (outcomes).ConclusionsWe identified three CMO configurations of Taiwanese medical students’ active learning. The connections between hierarchical culture, fear, teachers’ guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.
Ibudilast for Alcohol Use Disorder: Study protocol for a phase II randomized clinical trial
Authors: Burnette Elizabeth M. , Baskerville Wave-Ananda , Grodin Erica N. , Ray Lara A.
Published: July 2020

Background Alcohol use disorder (AUD) is a chronic and relapsing condition for which current pharmacological treatments are only modestly effective. The development of efficacious medications for AUD remains a high research priority with recent emphasis on identifying novel molecular targets for AUD treatment and to efficiently screen new compounds aimed at those targets. Ibudilast, a phosphodiesterase inhibitor, has been advanced as a novel addiction pharmacotherapy that targets neurotrophin signaling and neuroimmune function. Methods This study will conduct a 12-week, double-blind, placebo controlled randomized clinical trial of ibudilast (50mg BID) for AUD treatment. We will randomize 132 treatment-seeking men and women with current AUD. We will collect a number of alcohol consumption outcomes. Primary among these is percent heavy drinking days (PHDD); secondary drinking outcomes include drinks per day, drinks per drinking day, percent days abstinent, percent subjects with no heavy drinking days, and percent subjects abstinent, as well as measures of alcohol craving and negative mood. Additionally, participants will have the option to opt-in to a neuroimaging session in which we examine the effects of ibudilast on neural activation to psychosocial stress and alcohol cues. Finally, we will also collect plasma levels of proinflammatory markers, as well as subjective and biological (salivary cortisol) markers of stress response.Discussion This study will further develop ibudilast, a safe and promising novel compound with strong preclinical and clinical safety data for AUD, and will probe biological mechanisms underlying the effects of Ibudilast on stress, neuroinflammation, and alcohol cue-reactivity and craving. If ibudilast proves superior to placebo in this study, it will set the stage for a confirmatory multi-site trial leading to FDA approval of a novel AUD treatment. Trial Registration ClinicalTrials.gov, NCT03594435 “Ibudilast for the Treatment of Alcohol Use Disorder”, registered July 20, 2018.
Evaluation of Transition to Distance Education in COVİD-19 Pandemic
Authors: Kolcu Giray , Demir Sadettin , Gülle Kanat , Atay Tolga , Kolcu Mukadder İnci Başer , Koşar Alim
Published: July 2020

Background: As in the rest of the world, distance education methods have been introduced in higher education in our country. The aim of the study is to evaluate the satisfaction of the learning management system.Methods: The study was designed as a cross-sectional study with mixed research design. 467 students stated their opinions for the questionnaire (n: 467).Results: In the evaluation of the scale total scores, the mean was calculated as 17.72 ± 5.49 (min: 5, max: 25). Between the preclinical term and the clinical term, t-test was performed in independent groups, and there was a statistically significant difference between the averages.In the qualitative component of the study, students were asked to express their views on the positive and aspects that should be improved regarding distance education. In the content analysis of the open-ended question, 4 themes (LMS, Learning Process, Student-educator interaction, Assessment and evaluation).Conclusions: Our faculty evaluated distance education as an opportunity for change during the pandemic process and quickly adapted to the process. This reaction was positively perceived by students and expressed as satisfaction. In line with this satisfaction and effectiveness, we believe that the experience of pandemics can bring educational programs closer to blended learning by enriching with distance learning.
Evaluation of Patients' Satisfaction on Booking Appointment System in Dental School of Isfahan During 2018
Authors: Nilchian Firouzeh , ataie zahra , Jamshidian Hamid
Published: July 2020

Background: With the development of technology in recent years, booking appointment software systems have gained special and significant popularity among physicians and patients. For this purpose, this study aimed to improve the queuing services of Isfahan School of Dentistry, examine the types of booking systems of the School of Dentistry and report the level of patient satisfactionMethods: The study was descriptive and cross-sectional. The questionnaire was prepared using Zhang study in 2014 and the standard Forward-Backward translation method. In order to investigate the validity, the opinions of the professors of Isfahan Dental School were taken and the professional opinions of the individuals were applied. The questionnaire was distributed among patients referring to the dental school who had undergone the initial examination. After completing the data, SPSS software version 20 and descriptive and analytical statistical tests were used to analyze the data (a = 0.05).Results: In this study, independent t-test, Kruscal-Wallis test and Pearson correlation test were used to investigate the data. The Kruscal-Wallis test showed that overall satisfaction was significantly higher in patients who booked appointment online than in other patients (P = 0.003). The independent t-test showed that the mean scores of patient satisfaction with staff behavior (P = 0.03) and satisfaction with the waiting time (P = 0.01) were significantly different between native, non-native and passenger patients.Conclusion: Most of the people surveyed were generally relatively satisfied with the booking appointment services. Most of them surveyed came in person to queue. Most people cited cheap services as the main reason for their visits. Most people cited telephone busy signal as the reason for not using the telephone booking system.
Comparison of Molecular, Clinicopathological, and Pedigree Differences Between Lynch-like and Lynch Syndromes
Authors: Xu Yun , Li Cong , Guo Tian'an , Zhang Yuqin , Liu Fangqi , Xu Ye
Published: July 2020

Background: In this study, we compared the molecular, clinical, and pathological characteristics, as well as pedigrees, between patients with Lynch-like syndrome (LLS) and confirmed Lynch syndrome (LS) to develop appropriate management strategies for patients with LLS and their affected family members. Methods: Between June 2008 and September 2018, 81 patients with LLS and 47 patients with LS who developed colorectal cancer (CRC) were enrolled in this study. Multigene panel testing included 139 genes and was performed for all patients. The variants identified in each group were described, and clinicopathological characteristics and pedigrees were compared between the two groups. Results: In the LLS group, a total of 52 variants were detected in 44 (54.3%) patients. Among the 52 variants, 17 were variants of unknown significance in mismatch repair genes, and the other most frequently mutated genes were MUYTH, POLE, BRCA2, and GJB2. The proportion of early-onset patients was significantly higher among the LS probands than among the LLS probands (74.5% and 53.1%, respectively; χ2 = 5.712, P = 0.017). On the other hand, the proportion of primary CRC developed in the rectum was higher in the LLS group than in the LS group (25.9% and 10.6%, respectively; χ2 = 2.358, P = 0.046). There were no significant differences in the occurrence of metachronous CRC (P = 0.632) and extra-CRC (P = 0.145) between the two groups. However, analysis of pedigrees showed that more patients developed CRC in the LS families (P = 0.013), whereas more patients with extra-CRC were observed in the LLS families (P = 0.045). A higher prevalence of male patients was observed in the LLS families (P = 0.036). Conclusions: LLS should be classified as a mixed entity, containing cases of true LS, other hereditary cancer syndromes, and sporadic CRC. The high risks of CRC and extra-CRC, found in our study, suggest that aggressive surgical management should be performed for LLS probands. In addition, we recommend a stringent surveillance protocol that should involve regular follow-ups of the intestine and other organs for probands and affected family members.
Effectiveness of Fiberoptic Phototherapy Compared to Conventional Phototherapy in Treating Hyperbilirubinemia Amongst Term Neonates: a Randomized Control Trial
Authors: Joel Helvi Ndeshihala , Mchaile Deborah , Philemon Rune , Mbwasi Ronald , Msuya Levina
Published: July 2020

Background
Neonatal jaundice is one of the most common problems in newborns. Effective treatment of jaundice requires therapeutic intervention with phototherapy (PT). Conventional phototherapy has been used for more than 50 years, but has been linked with adverse outcomes. Over recent years, several studies suggest fiberoptic phototherapy has been seen to be as effective as conventional phototherapy in preterm newborns with minimal adverse outcomes, however it was found to be less effective than conventional phototherapy in term neonates. These findings were attributed to the illuminated area and irradiance of the fiberoptic units used in previous studies. Our study aimed to compare the effectiveness of fiberoptic phototherapy unit with a larger illuminated area and higher irradiance to conventional phototherapy methods.
Methods
This was a randomized control trial conducted at Kilimanjaro Christian Medical Centre (KCMC). A total of 41 term neonates, less than 7 days of age with unconjugated hyperbilirubinemia were randomized. Thirteen (13) newborns were allocated to receive fiberoptic phototherapy, 13 for blue light conventional phototherapy and 15 for white light conventional phototherapy. Effectiveness was assessed by comparing the duration of phototherapy, bilirubin reduction rate and treatment side effects. The data was evaluated with the independent t-test.
Results
The mean overall bilirubin reduction rate (as %/h) was comparable in the fiberoptic phototherapy group (0.74%/h) and the blue light conventional phototherapy group (0.84%/h), with no statistically significant difference (p-value 0.124). However, white light conventional phototherapy had a significantly lower overall mean bilirubin reduction rate (0.29%/h) as compared to fiberoptic phototherapy (p-value < 0.001). The mean treatment duration of phototherapy was 69 h, 68 h and 90 h in the fiberoptic, blue light conventional and white light conventional phototherapy groups respectively. Side effects such as loose stool and skin rash were noted in some participants who received conventional phototherapy. No treatment side effects were noted in the fiberoptic phototherapy group.
Conclusion
The results confirm and quantify the benefits of increasing surface-area exposure and irradiance of the fiberoptic phototherapy unit. Fiberoptic phototherapy mitigates side effects caused by conventional phototherapy.
Trial registration:
The Pan African Clinical Trial Registry, PACTR202004723570110. Registered 22nd April 2020- Retrospectively registered, http://www.pactr.org/
Regulation of Prdx6 by Nrf-2 is mediated through aiPLA2 in white matter reperfusion injury
Authors: Daverey Amita , Agrawal Sandeep K.
Published: July 2020

BackgroundMechanisms involving upregulation of cytoprotective genes under the control of transcription factors, such as Prdx6 and Nrf2, exist to protect cells from permanent damage and dysfunction under hypoxic conditions. Hypoxia and reperfusion produces overproduction of ROS (reactive oxygen species), which may lead to mitochondrial dysfunction leading to cell death and apoptosis. Here, we explore the hypothesis that Prdx6 protects the spinal cord white matter from hypoxia-reperfusion injury and elucidate the possible mechanism by which Prdx6 elicits its protective effects.MethodsBriefly, rats were deeply anesthetized with 5% isoflurane and maintained at 1.5%-2.5% isoflurane. A 30 mm section of spinal cord was rapidly removed and placed in cold Ringer’s solution (2-4 °C), and then a dorsal column segment was micro-dissected from the spinal cord and adjacent gray matter after longitudinal sectioning. The dissected dorsal column was exposed to hypoxia by perfusing 95% N 2 /5% CO 2 for 1 h. For reperfusion experiments, the Ringer’s was reperfused with 95% O 2 and 5% CO 2 for 2 h and 4 h.ResultsOur results show that the expression of Prdx6 significantly upregulated in white matter after hypoxia compared to the sham group, whereas reperfusion caused a gradual decrease in Prdx6 expression after 2 h and 4 h of reperfusion injury. For the first time, our study revealed the novel expression and localized expression of Prdx6 in astrocytes after hypoxia, and possible communication of astrocytes and axons through Prdx6. Interestingly we observed a gradual increase in Nrf2 expression, which suggests a negative regulation of Prdx6 through Nrf2 signaling. Furthermore, inhibition of aiPLA2 activity of Prdx6 by MJ33 shows that the regulation of Prdx6 by Nrf2 is mediated through aiPLA2 activity.ConclusionThe present study uncovers a differential distribution of Prdx6 in axons and astrocytes under a hypoxic environment of white matter, and regulation of Prdx6 in hypoxia-reperfusion injury. Our data show that low levels of Prdx6 in reperfusion injury leads to increased inflammation and apoptosis in white matter, therefore the results of this study suggests that Prdx6 has a protective role in spinal hypoxia-reperfusion injury.
Modeling the Acceptance and Use of Electronic Medical Records from Patients’ Point of View: Evidence from Saudi Arabia
Authors: Bamufleh Dalal
Published: July 2020

Background

The employment of IT in healthcare reflects a need to meet the increasing demands of patients and to upgrade the quality and productivity of the provided services. However, the literature demonstrates many failures in systems and IT technology implementation in the context of healthcare. One of the reasons behind these failures is users’ resistance to accept such new technology. The ministry of health in Saudi Arabia has prioritized the embracing of new technologies that could level up the healthcare service, such as the adoption of electronic medical record (EMR) systems. On the other hand, studies that address the acceptance and use of hospital information systems and EMRs in Saudi Arabia from patients’ points of view are scarce. The aim of this study was to explore patients’ acceptance of an EMR system by testing a proposed theoretical model adapted from the technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT).
Methods

An online questionnaire was used where questions were based on the proposed model constructs (facilitating conditions, perceived ease of use, perceived usefulness, attitude, and behavioral intention). One hundred sixteen patients responded to the questionnaire. The model was then tested using the structural equation modeling method to identify the factors that affect patients’ intention to use the online services of the EMR.
Results

The analysis of the research model suggested that (1) facilitating conditions that involved patients’ knowledge, skills, and the provided support by the hospital directly influenced the degree of perceived ease of use (PEOU) of the system. (2) PEOU directly affected the EMR’s perceived usefulness (PU). (3) PU directly affected patients’ attitudes (ATT) toward using the EMR. (4) A positive effect is found between ATT and the behavioral intention to use EMR.
Conclusion

The study results have implications for healthcare IT acceptance research and efforts in Saudi Arabia, as to date patients’ perspectives have received little attention. The research also makes a theoretical contribution as it validated the proposed model, which integrated constructs from TAM and UTAUT.
Connected Diagnostics to Improve Accurate Diagnosis, Treatment, and Conditional Payment of Malaria Services in Kenya.
Authors: Duijn Shannen Van , Siteyi Angela , Smith Sherzel , Milimo Emmanuel , Stijvers Leon , Oguttu Monica , Amollo Michael , Okeyo Edward , Dayo Lilyana , Kwambai Titus , Onyango Dickens , de Wit Tobias Rinke
Published: July 2020

Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is decreasing and transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to markedly improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya. The objective of this study is to evaluate feasibility, user experience, clinical performance and of Connected Diagnostics in Kisumu and to assess over-prescription of antimalarials. Methods: Our intervention was performed Oct 2017 – Dec 2018 across seven providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled for malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results: In total 11,689 febrile patients were tested. Malaria positivity rates ranged from 7.4% to 30.2% between providers, with significantly more positive cases amongst the poor (p< 0.05). Over-prescription of antimalarials was 28%, fluctuating between 4.6% to 63.3% per provider. Prescription of branded versus generic antimalarials was dichotomous. Challenges were encountered transitioning from microscopy to RDT. Conclusion: We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improving potential.
Detection and characterisation of Leptospira spp. in dogs diagnosed with kidney and/or liver disease
Authors: Rahman Mohammad Sabri Abdul , Khor Kuan Hua , Bejo Siti Khairani , Lau Seng Fong , Mazlan Mazlina , Roslan Mohd Azri , Goh Soon Heng
Published: July 2020

Background

Leptospirosis is a zoonotic bacterial disease that affects both humans and animals. In humans, a wide range of symptoms had been described but in dogs, it is commonly associated with kidney and/or liver disease. In Malaysia, information with regards to the common serovars causing leptospiral infection in dogs remains limited. Therefore, this study investigated the occurrences of leptospiral infection in 124 pet dogs diagnosed with kidney and/or liver disease in Malaysia.
Results

Based on microscopic agglutination test, 42.7% (53/124) of the dogs were seropositive for leptospiral infection. The predominant serovars detected were Bataviae (n = 12), Javanica (n = 10) and Icterohaemorrhagiae (n = 10). The direct detection using polymerase chain reaction showed that 33.9% (42/124) of the whole blood and 31.9% (36/113) of the urine samples were positive to pathogenic Leptospira spp. For tissue samples, 9.1% (2/23) of the kidney and 9.1% (2/23) of liver were positive for pathogenic Leptospira spp. Addition samples of abdominal effusion from four dogs were positive for pathogenic Leptospira spp. The species detected were L. interrogans, L. borgpetersenii, L. kirshneri and L. kmetyi by partial 16S rRNA sequencing. In this study, 11 Leptospira spp. isolated successfully from the eight dogs were further identified and characterised as Bataviae, Javanica and Australis. Unfortunately, the mortality rate of the infected dogs was high at 34.0% (18/53).
Conclusions

This study allowed for greater understanding of canine leptospirosis through the provision of crucial diagnostic confirmation.
Geriatric Depression in the Emergency Department of a Teaching Hospital in Nepal: Prevalence, Contributing Factors, and Metric Properties of 5 item Geriatric Depression Scale in this Population
Authors: Shrestha Roshana , Shrestha Anmol Purna , Shrestha Abha , Kamholz Barbara
Published: July 2020

Background
Depression is prevalent but poorly recognized in the Emergency Department (ED). We aimed to determine the prevalence of geriatric depression and its possible determinants in the ED using the 15-item geriatric depression scale (GDS). We also aimed to explore the performance of the shorter, five-item GDS as compared to the 15-item GDS.
Methods
This was a cross-sectional study with convenience sampling of the ED patients ≥ 60 years. The previously validated Nepali version of GDS-15 screened the sample into “no”, “mild-moderate” and “severe" depression using cutoff values of 4/5, and 8/9 respectively. Demographic and socioeconomic factors, comorbidities and health seeking behaviour were studied and the relation was assessed with binary (Chi-square and Kruskal-Wallis test) and multinomial regression analysis. The performance of GDS-5 was compared with the GDS-15 as standard. Cronbach’s alpha was calculated to investigate reliability. Validity was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, Spearman’s correlation, receiver operating characteristic curve, and kappa coefficient.
Results
280 patients were enrolled with an overall prevalence of depression of 45.7% [104 (81.3%) mild-moderate depression, and 24 (18.8%) severe depression]. The mean age of the sample was 71.36 with female predominance (61%), and 82.5% were illiterate. In the binary analysis, those who had more pain, visited the ED more often, had musculoskeletal diseases and sleep problems, mobility problems, visited local healers previously, and who reported self-perceived “heart and mind” disease showed statistically significant differences among the three categories. In multinomial regression analysis, visits to local healers, sleep problems and frequency of pain were significantly related to depression. The sensitivity, specificity, area under curve and Spearman’s correlation of GDS-5 were 75.8%, 96%, 0.919, and 0.827 respectively. Cronbach's alpha for GDS-5 was low (0.416), therefore a new version was proposed which improved the sensitivity to 90.6% and Cronbach’s alpha to 0.623.
Conclusions
Geriatric depression was highly prevalent which urges the need for ED-based interventions for screening and referral. The proposed brief GDS-5 correlated well with the GDS-15 with better validity and internal reliability and offers a more expeditious form of screening for geriatric depression in emergency settings in Nepal.
Factors Affecting Root Migration After Coronectomy of the Mandibular Third Molar
Authors: Lee Nan-ju , Jung Seo-Yeon , Park Kyeong-Mee , Choi Yiseul , Huh Jisun , Park Wonse
Published: July 2020

Background The purpose of this study was to analyze root migration and its influencing factors at 6 months after coronectomy in both two- and three-dimensions using periapical view and cone-beam computed tomography (CBCT). Methods Thity-three cases of root remnant after coronectomy were analyzed. We measured the amount of migration in CBCT. The following factors that could possibly affect root migration were also analyzed: age, gender, number of mandibular third molar (M3) roots, shape of M3s, Pell and Gregory classification, mesiodistal (MD) angulation, buccolingual (BL) angulation, contact point with the second molar, root curvature, and complete removal of the coronal portion. Results Migration of greater than 2 mm was found in 64% of the roots in the 2D analysis, and the average root migration was 4.11 mm in the 3D analysis. The factors affecting migration were the root morphology, complete removal of the coronal portion, impaction depth, and MD angulation in the 2D analysis, and MD and BL angulation in the 3D analysis. Conclusion In conclusion, complete removal of the coronal portion and ensuring sufficient space for root migration might be important factors after coronectomy of the M3. Clinical relevance Root remnant after coronectomy of M3 may migrate in young patients who has sufficient empty coronal space and this may reduce the nerve damage by the separation of IAN and M3.
“It’s really no more difficult than putting on fluoride varnish”: A qualitative exploration of dental professionals’ views of silver diamine fluoride for the management of carious lesions in children
Authors: Seifo Nassar , Cassie Heather , Radford John , Innes Nicola
Published: July 2020

Background: Despite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, there is still limited use the UK. This study explored dental professionals’ views and experiences of using SDF for managing carious lesions in children. In addition, it explored what they perceived to be the advantages, disadvantages, barriers and enablers to the use of SDF in practice.Methods: Fifteen semi-structured face-to-face or over-the-phone interviews were conducted with 14 dental professionals from NHS Tayside and NHS Grampian in Scotland. Interviews were transcribed verbatim, coded and analysed using a framework approach.Results: Thirteen of 14 dental professionals interviewed were familiar with, or had some existing knowledge of, SDF. Four had used it to treat patients. The majority of participants thought that the main advantage of SDF was that it required minimal patient cooperation. Silver diamine fluoride was also perceived as a simple, pain-free and non-invasive treatment approach that could help acclimatise children to the dental environment. However, SDF-induced black staining of arrested carious lesions was most commonly reported as the main disadvantage and greatest barrier to using it in practice. Participants believed that this discolouration would concern some parents who may fear that the black appearance may instigate bullying at school and that others may judge parents as neglecting their child’s oral health. Participants thought that education of clinicians about SDF use and information sheets for parents would enhance the uptake of SDF in dental practice. Participants believed that younger children might not be as bothered by the discolouration as older ones and they anticipated greater acceptance of SDF for posterior primary teeth by both parents and children.Conclusion: Dental professionals were aware that SDF can be used for arresting carious lesions. They pointed out that the staining effect of carious lesions is a major disadvantage that could be a barrier for many parents. Participants considered the application process to be simple and non-invasive and requires a minimum level of child’s cooperation. Participants appreciated the potentials of SDF in paediatric dentistry and suggested actions that could help overcome the barriers they highlighted.
The Impact of COVID-19 Pandemic on Dental Practice: A Questionnaire-Based Report
Authors: Ahmadi Hanie , Ebrahimi Alireza , Ghorbani Farhad
Published: July 2020

Background: The highly contagious nature of the novel coronavirus, besides the fact that dental procedures commonly generate blood and saliva droplets that are the routes of contagion lead to the closure of many dental clinics. In the present study, we aimed to evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic on dental practice by conducting an online questionnaire among dental practitioners and finding their perspective on the subject.Methods: This report is based on a questionnaire that was conducted among Iranian dentists. The survey included questions that evaluate the dentists’ attitudes toward the COVID-19 pandemic and its effect on their personal life, financial status, and the quality of dental services for patients. Results: Overall, 240 dentists contributed to this study (214 general dentists and 26 specialists). The majority of the participants (n=219, 91%) did not perform non-emergency procedures during the pandemic. 162 (67%) of the contributors asserted that the COVID-19 test must be performed for the patients before any dental procedure and 234, (97%) of them reported that they encountered a decrease in their financial income since the pandemic.Conclusion: Most of the Iranian dentists performed just non-emergency treatments and reduced their work hours during the pandemic. They executed standard protocols more cautiously than the past, and affirmed that public organizations should support the dental practitioners during the pandemic.
Prevalence of Tumor Necrosis Factor Alpha Inducing Protein (tipα) Gene of Helicobacter Pylori and Its Association with Upper Gastrointestinal Diseases in India
Authors: Mahant Shweta , Mehra Shubham , Chhawchharia Ayushi , Karmakar Bipul Chandra , Paul Sangita , Mukhopadhyay Asish Kumar , Bose Sudeep , Das Kunal , Das Rajashree
Published: July 2020

Background: Helicobacter pylori (H. pylori) is known to cause several gastro-duodenal diseases including chronic Gastritis, Peptic Ulcer disease and Gastric Cancer. Virulent genes of H. pylori like cagA, vacA are known to be responsible for the disease pathogenesis. But these virulence genes are not always found to be associated with disease outcome in all populations around the world. Relationship of H. pylori with Gastro Esophageal Reflux Diseases is controversial and uncertain. Tumor necrosis factor alpha inducing protein tipα is a new discovered virulent gene of H. pylori and is an inducer of certain cytokines and chemokines that are responsible for causing stomach cancer. Therefore, we conducted a study which aims to find the prevalence of tipα gene in the Indian population and its association with H. pylori related upper gastrointestinal diseases.Results: The current study shows the prevalence rate of tipα gene in the Indian population to be 59.9%. Our study has found a significant association (p < 0.05) of tipα gene with Non Ulcer Dyspepsia (NUD) and also an association of cagA and vacAs1m1 with Gastritis and Duodenal Ulcer.Conclusion: Our study demonstrates for the first time the presence of tipα as virulent factor of H. pylori strain in Indian population isolated from patients suffering from upper gastrointestinal diseases. Further, tipα is significantly associated with NUD but not with other upper gastrointestinal diseases in India.
Bacteriological and Molecular Detection of Methicillin-resistant Staphylococcus Aureus Isolated From Cigarette and Hookah Smokers in Khartoum State
Authors: Osman Jara Osman Ali , Bakri Esraa abdulraman Abdallah , Hashim Ahmed Ibahim , Alla Ahmed Bakheet Abd , Altayb Hisham N , Hamedenil Yousif Fadlallah
Published: July 2020

Objective

Staphylococcus aureus is an extra-ordinarily versatile pathogen that causes a wide variety of infections in humans and animals, capable of causing superficial lesions and systemic infections. The aim of this study was to detect mecA gene in smokers of cigarette and hookah.
Results

Forty-one isolates (41%) were identified as S. aureus by traditional culture methods. non-smokers, nasal carriers of S. aureus were 16 (39%) while 25 (60%) among smokers (P = 0.103). Of the overall 25 smoker nasal carriers, 18 were hookah smokers and 7 were cigarettes smokers (P = 0.004). MRSA was 1 (2.4%) in non-smokers and 3 (7.2%) in smokers, 2 in cigarettes and 1 in hookah (P = 0.009). Only 38 isolates were confirmed as S. aureus by PCR (mecA gene). In non-smokers group mecA were 6 (15.8%) positive and 8 (21%) negative, while in smokers were 16 (42.3%) positive and 8 (20.9%) negative isolates (P = 0.187). From hookah 12 mecA positive and 4 from cigarette (P = 0.647). The correlation of MRSA and using of antibiotic during last 6 months indicates significant (P = 0.031).
The Effect of Royal Jelly and Tocotrienol-rich Fraction Along With Calorie Restriction on Hypothalamic Endoplasmic Reticulum Stress and Adipose Tissue Inflammation in Diet-induced Obese Rats
Authors: Irandoost Pardis , Alamdari Naimeh Mesri , Saidpour Atoosa , Shidfar Farzad , Farsi Farnaz , Jafarabadi Mohammad Asghari , Alivand MohammadReza , Vafa Mohammad Reza
Published: July 2020

Objectives
Endoplasmic reticulum (ER) stress causes adipose tissue dysfunction and chronic inflammation in obesity. Royal jelly (RJ) and tocotrienol-rich fraction (TRF) are reported to ameliorate inflammation. However, the improving effects of RJ and TRF on inflammation from ER stress modulating view have not been assessed so far. Hence, we investigated the effect of RJ and TRF on ER stress and some adipose tissue-derived inflammatory markers in the high-fat diet (HFD)-induced obesity. Wistar obese rats randomly allocated into 5 groups: HFD, calorie restriction diet (CRD), RJ + CRD, TRF + CRD, RJ + TRF + CRD. After 8-week intervention, adipose tissues and hypothalamus were dissected and serum was collected.
Results
RJ reduced glucose-regulated protein-78 (GRP78) expression as ER stress indicator in WAT and hypothalamus compared to CRD. Beside RJ diminished the expression of inflammatory markers in white adipose tissue (WAT) and also decreased the serum concentration of them. TRF reduced inflammatory markers in the serum of obese rats but the effect of TRF on ER stress was not remarkable. Overall, RJ decreased WAT and hypothalamic ER stress and diminished secretion of inflammatory markers of WAT in obesity. Thereby RJ has protective effect against adipose tissue dysfunction and inflammation then suggested as a therapeutic approach to reduce some obesity-related complications.