Reopening Dental Offices for Routine Care Amid the COVID-19 Pandemic: Report From Palestine

ObjectivesThis study reports on the readiness of Palestinian dentists to reopen their practices for routine care during the current coronavirus disease 2019 (COVID-19) pandemic.MethodsA cross-sectional study targeted dentists in the West Bank area of Palestine using an online survey during the first 2 weeks of May 2020. Questions mainly asked about dentists’ perception of the risks of COVID-19, readiness to reopen their clinics for routine care, and the level of confidence in dealing with patients suspected of having COVID-19.ResultsA total of 488 dentists completed the survey. Almost 60% believed that they were not ready to reopen their practices. Almost 13% had “no confidence” in dealing with patients with COVID-19, while 64% had “little to moderate” confidence. Confidence was correlated negatively with increased fear of becoming infected (ρ = -0.317, P < .0001) and positively with years of practice (ρ = 1.7, P < .0001). Dentists who received updated training on infection control or on COVID-19 reported higher levels of confidence (χ² = 53.8, P < .0001, χ² = 26.8, P < .0001, respectively). Although 88% preferred not to treat patients with COVID-19, 40% were willing to provide care to them. Almost 75% reported that they were already facing financial hardships and could not survive financially until the end of the current month.ConclusionsEthical and financial reasons were the main drivers for dentists in this sample to reopen their practices for routine care. Data from this study highlights the fragility of private dental practice in emergency situations. Ethical, health, and financial challenges that emerged during COVID-19 require dentists to adapt and be better prepared to face future crises.     

脂肪干细胞体外分离培养鉴定及免疫学性质

背景：脂肪干细胞由于具备易于获取等特点,在组织工程中比骨髓间充质干细胞具有更加广阔的应用前景,并因此成为当今的研究热点之一。目的：观察脂肪干细胞的生长规律,鉴定其干细胞特性和免疫学性质。方法：自整形外科行抽脂的3名健康志愿者身上获取皮下脂肪组织及外周血,志愿者年龄20一30岁,均为女性。用I型胶原酶消化脂肪组织获得脂肪干细胞,在体外原代培养及传代培养,观察其体外增殖能力等生物学特性;通过流式细胞术检测人脂肪干细胞分化群表面抗原和主要组织相容性抗原的表达。并将异体脂肪干细胞和淋巴细胞共培养,观察脂肪干细胞是否可以刺激后者增殖。结果与结论：所获脂肪干细胞具有很强的体外增殖能力,其生长曲线呈“S”形;第3代脂肪干细胞表面CD29、CD44、CD90以及主要组织相容性抗原I呈阳性表达,CD31、CD45、CD34及主要组织相容性抗原II呈阴性表达;未发现异体脂肪干细胞刺激淋巴细胞增殖。提示所获细胞确为脂肪干细胞,且具有较弱的排斥反应,有可能成为细胞治疗或组织工程的同种异体细胞来源。     

First Report on Sergentomyia sintoni and Sergentomyia clydei (Diptera: Psychodidae): Their Natural Promastigote Infection and Some Aspects of Biology in Sistan-Baluchistan Province,Southeastern Iran

ObjectiveTo This paper has explained initial survey on two vectors of lizard leishmania promastigote in south-east of Iran.MethodsTotally 333 S. sintoni and 475 S. clydei were collected from rodent burrows by sticky traps in three villages of Chabahar County. Sand flies were dissected in a drop of normal saline.ResultsNatural leptomonad infection rate involved %2.1 S. sintoni and %5 S. clydei. The finding about seasonal variation was showed the highest infection rate in two vectors in the first week of August. The highest population of gravid and semi-gravid of main vectors of Lizard leishmaniasis, S. sintoni and S. clydei, were observed in the last week of September and the lowest were in the last week of July. The examination of accessory glands showed that the maximum population of parous was observed in the last week of September and the last week of July it was at least. This is the first report of leptomonad (promastigote) infection in S. sintoni and S. clydei in Sistan-Baluchistan Province, southeastern Iran.ConclusionsA further study with more focus on biology of Sergentomyia genus is suggested.     

Hydrophilic polymer vasculopathy with coinciding pseudoxanthoma elasticum‐like changes in an amputated toe

For the past decades, hydrophilic polymer gel coating have been widely used on endovascular devices to decrease friction and to aid with binding and delivering of medications in drug‐eluting stents. In the recent years, hydrophilic polymer emboli disease has been recognized as an iatrogenic adverse effect which has led to considerable morbidity and mortality of patients. This under‐recognized embolic phenomenon now has reproducible pathognomonic histologic findings. Small‐ to medium‐sized blood vessels are occluded with basophilic, amorphous, non‐refractile, non‐polarizable and whirled aggregates of foreign body material. Depending on the affected organ, the patients have variable symptomatology, from livedo racemosa, gangrene of extremities to cardiac arrhythmias, hemiparesis, stroke and death. Here, we present a unique case of hydrophilic polymer vasculopathy 6 years post‐endovascular procedure with coinciding pseudoxanthoma elasticum‐like changes. As the literature has seen increased reporting of individual cases and case series documenting the patients’ diverse symptomatology; hydrophilic polymer vasculopathy should be entertained sooner in the patient's differential diagnosis.     

Effects of voice therapy as objectively evaluated by digitized laryngeal stroboscopic imaging

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.     

Effect of low-dose aspirin on the development of ovarian hyperstimulation syndrome and outcomes of assisted reproductive techniques in the women with PCOS,a randomized double-blinded clinical trial

Objective

Ovarian hyperstimulation syndrome (OHSS) is a major complication of assisted reproductive technologies (ART). Polycystic ovary syndrome (PCOS) is a risk factor for OHSS. The aim of this randomized clinical trial (RCT) was to study the effect of low-dose aspirin (LDA) on the development of OHSS and ART outcomes in PCOS during ART.

An open trial of citalopram in children and adolescents with depression

OBJECTIVE: The aim of this study was to collect pilot data on the magnitude of effect and tolerability of citalopram in early-onset major depressive disorder (MDD). METHOD: This study was performed in two academic child and adolescent psychiatric clinics (2000 through 2002). Thirty children and adolescents, 8-17 years of age (mean age, 13.57 +/- 2.5), of both sexes (53.3% girls; 46.7% boys) and diagnosed with MDD by means of clinical psychiatric evaluation, Diagnostic Interview for Children and Adolescents (DICA) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria, were studied in an open-label clinical trial with 10-40 mg/day of citalopram for 6 weeks. The outcome measures were the Hamilton Depression Rating Scale (HDRS), the Children Global Assessment Scale (CGAS), and the New York State Psychiatric Institute side-effect form. RESULTS: Moderate (50%-70% change in HDRS and CGAS) to large (> 70% change in HDRS and CGAS) effect were seen in 91.7% of children (22/24). There were significant changes on HDRS (X = 22.78; t = -14.12; p < 0.000) and CGAS (X = 26.02; t = 9.68; p < 0.000) between baseline and the 6th week. Mild side effects were reported in 2 patients (8.3%). Adverse effects that contributed to discontinuation were nausea and vomiting in 3.3% (n = 1) of patients and unexpectedly switching to mania in 16.7% (n = 5) of patients. CONCLUSION: Citalopram may be an efficatious treatment in early-onset MDD. However, the high switch rate to mania warrants further investigations, as well as cautions, in using it.     

Integrating clinical practice guidelines into daily practice: impact of an interactive workshop on drafting of a written action plan for asthma patients

INTRODUCTION: Written action plans (WAPs) are instructions that enable asthmatics to manage their condition appropriately and are recommended by current asthma clinical practice guidelines (CPGs). However, general practitioners (GPs) rarely draft WAPs for their patients. An interactive, case-based workshop for asthma, combined with an objective structured clinical examination (OSCE), was developed to increase GPs' knowledge and use of WAPs in Québec. METHODS: The study compared 24 GPs receiving an OSCE preworkshop and 12 months post-workshop (group 1) with 16 GPs receiving an OSCE preworkshop and at 6 and 12 months post-workshop (group 2). Participants received no feedback on their OSCE performance. During the workshop, which presented a preformatted tool to aid drafting of the WAPs, all 40 GPs worked individually and in small groups to answer questions on a hypothetical clinical case and then discussed the responses with a facilitator and an asthma specialist. RESULTS: Only group 2 GPs showed a significant improvement in knowledge of WAPs 12 months post-workshop (p = .01). The likelihood of prescribing WAPs to patients increased in group 2 to a degree approaching statistical significance (p = .070), and there was a borderline nonsignificant trend for prescribing practice to improve more among group 2 GPs than among group 1 GPs (p = .052). There was also a nonsignificant trend for 6-month OSCE to increase attendance at the 12-month OSCE. DISCUSSION: An interactive workshop employing a preformatted WAP tool and a reinforcing OSCE at 6 months yielded improved knowledge of WAPs at 1 year. Although originally developed as a form of evaluation, the OSCE appears to have formative value even when correction is not provided and may increase the effectiveness of continuing medical education interventions to enhance CPG implementation.