Optimizing anterior laryngeal exposure during direct suspension laryngoscopy in adults

An analysis of the literature on laryngeal exposure during direct suspension laryngoscopy in adults summarized the resources available to improve visualization, specifically at the anterior commissure.

Hematologic Manifestations of Parvovirus B19 Infection

Parvovirus B19 virus infection is widespread among humans because of its highly infectious and obstinate nature, with up to 80% of the population testing positive for IgG antibodies against the virus. Pronormoblasts observed in biopsy are the hallmarks of PVB19 infection. In addition, PVB19 affects the skin, heart, brain, joints, and liver and can be diagnosed through antibody detection or DNA detection via PCR. Due to its capsid proteins' high affinity for bone marrow receptors, its main presentation is the suppression of bone marrow functions. It has been shown to affect patients with hemolytic anemia and patients with hematological malignancies, presenting with pure red cell aplasia. The main available effective treatment option is IV immunoglobulins; however, the risk of recurrence remains high after treatment.

Retrospective validation of the postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a developing country

Background

The characteristics of premature infants vary from country to country rendering it challenging to apply retinopathy of prematurity (ROP) screening algorithm globally. The screening criteria for postnatal growth and ROP (G-ROP) for preterm infants are known to be beneficial, but it is not clear whether these criteria can be used universally.

Aim

The aim of this study is to validate the accuracy of the G-ROP criteria in screening preterm infants in Saudi Arabia.

Subjects and Methods

This single-center retrospective study included 300 premature infants (mean gestational age [GA], 28.72 ± 2.2 weeks; range, 21-36 weeks) at a referral center who were screened for ROP between 2015 and 2021. The inclusion criteria were the availability of data on ROP outcome and body weight up until day 40 after birth. The G-ROP 1 and G-ROP 2 models were examined for their ability and accuracy in identifying infants with any stage ROP and treatable ROP.

Results

The G-ROP 1 and G-ROP 2 models identified 233 and 255 infants for screening, respectively. The sensitivity of G-ROP 1 and G-ROP 2 for detecting treated ROP was 96.7% and 100%, respectively, and the specificity for detecting treatable ROP was 24.4% and 16.7%, respectively. Incorporation of the G-ROP 2 model, which did not miss any infant with type 1 ROP, would have reduced the number of screened infants by 15%.

Conclusion

G-ROP 2 was more sensitive than G-ROP 1 for identifying infants who required treatment and could potentially reduce the burden of ROP screening.

Biallelic TET2 mutations confer sensitivity to 5'-azacitidine in acute myeloid leukemia

Precision medicine can significantly improve outcomes for patients with cancer, but implementation requires comprehensive characterization of tumor cells to identify therapeutically exploitable vulnerabilities. Here, we describe somatic biallelic TET2 mutations in an elderly patient with acute myeloid leukemia (AML) that was chemoresistant to anthracycline and cytarabine but acutely sensitive to 5'-azacitidine (5'-Aza) hypomethylating monotherapy, resulting in long-term morphological remission. Given the role of TET2 as a regulator of genomic methylation, we hypothesized that mutant TET2 allele dosage affects response to 5'-Aza. Using an isogenic cell model system and an orthotopic mouse xenograft, we demonstrate that biallelic TET2 mutations confer sensitivity to 5'-Aza compared with cells with monoallelic mutations. Our data argue in favor of using hypomethylating agents for chemoresistant disease or as first-line therapy in patients with biallelic TET2-mutated AML and demonstrate the importance of considering mutant allele dosage in the implementation of precision medicine for patients with cancer.

An in silico analysis of the impact of POLE mutations on cladribine docking

OBJECTIVE

Polymerase ε exonuclease (POLE) is an enzyme involved in DNA replication and may be an attractive therapeutic target in various cancers. Here we sought to model the impact of specific POLE mutations on protein function. Due to the lack of a crystal structure, the tertiary structures of the wild type and four common mutants were modeled using I-Tasser server.

MATERIALS AND METHODS

Molecular docking and dynamic simulation studies were performed, and the structure and function of the mutants analyzed through residue conservation analysis and protein folding energy changes.

RESULTS

All mutants of POLE gene had favorable binding affinities compared with their wild type of counterpart. The P286R variant, but not the other variants, disrupted cladribine binding to the protein. Similarly, dynamics studies revealed instability of the P286R mutant, while V411L, L424V, and L424F appeared to favor cladribine binding.

CONCLUSIONS

Since P286R is a hotspot mutation in endometrioid carcinomas, patients with this variant may not respond to cladribine. Population-based pharmacogenomics studies will be required to validate our results.

Frequency of ocular manifestations in multiple sclerosis patients admitted in tertiary care hospital in Saudi Arabia

OBJECTIVE

Multiple Sclerosis (MS) is one of the most destructive demyelinating diseases of the nervous system, and it manifests through broad involvement of the visual system. The present study was aimed to evaluate the frequency of ocular symptoms among MS patients admitted to the Kingdom Hospital in Saudi Arabia PATIENTS AND METHODS: This is a cross-sectional study aiming at investigating the prevalence of eye disease among MS patients referred to Hawtat Sudair Hospital, Zulfi General Hospital, Majmaah General Hospital, and Kingdom Hospital in Riyadh (Saudi Arabia) from January 2020 to December 2020. The sample size was made of 100 MS patients including 50 males and 50 females, all presented with eye disorders. The data were analyzed with SPSS 25, Chi-square test, and descriptive statistics.

RESULTS

The examined patients included 100 patients with MS symptoms aged 35 years, ranging from 20 to 70 years. The results showed a considerable lack of sharpness of vision among patients (80%), and the rate of double vision was reported to be about 49% among them which was the most prevalent vision problem from the onset of the disease until the examination time.

CONCLUSIONS

The achieved data from this study demonstrated that multiple sclerosis could cause eye diseases. Initial recognition of this syndrome provides the possibility of having an appropriate evaluation of patients to clinicians. Moreover, after the prevalence of MS, other ocular symptoms may occur consequently.

Genome-wide association study identifies susceptibility loci for acute myeloid leukemia

Acute myeloid leukemia (AML) is a hematological malignancy with an undefined heritable risk. Here we perform a meta-analysis of three genome-wide association studies, with replication in a fourth study, incorporating a total of 4018 AML cases and 10488 controls. We identify a genome-wide significant risk locus for AML at 11q13.2 (rs4930561; P = 2.15 × 10-8; KMT5B). We also identify a genome-wide significant risk locus for the cytogenetically normal AML sub-group (N = 1287) at 6p21.32 (rs3916765; P = 1.51 × 10-10; HLA). Our results inform on AML etiology and identify putative functional genes operating in histone methylation (KMT5B) and immune function (HLA).

Comparison of MALDI-TOF mass spectrometry with phenotypic methods for identification and characterization of Staphylococcus aureus causing mastitis

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection is one of the greatest threats to both animal and human health. Our investigation was aimed to identify and differentiate between MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) recovered from mastitic milk using MALDI-TOF mass spectrometry compared with phenotypic methods and studying their susceptibility to various antibiotics. Four hundred milk samples from mastitic animals (cows, sheep, goats, and dromedary camels) were investigated. Phenotypic identification of S. aureus was made through MASTASAPH Latex test, STAPH ID 32, and Vitek 2 system. The proteomic characterization of S. aureus was done by MBT. The Kirby Bauer method was accomplished to detect the resistance of S. aureus strains to antibiotics. The results of the MASTASAPH Latex test, revealed that 54 (46%) were recognized as S. aureus. All S. aureus isolates were identified by MBT with a score of more or equal 2.00. Several peaks were identified in the mass of 4590 Da, 4863 Da, and 4938 Da for MSSA and in the mass of 2636 Da and 3009 Da for MRSA. The MSP dendrogram demonstrated that the S. aureus isolates were classified into one group with a distance level of less or equal 400. The percentage of S. aureus resistance against carbenicillin, erythromycin and kanamycin was 94.4%, 38.88%, and 33.33%, respectively. In conclusion, S. aureus bacteria are among the key triggers for mastitis in Saudi Arabia. MBT is reported to be not only the rapid tool to identify S. aureus but also able to discriminate MRSA from MSSA.

Dental anxiety, child-oral health related quality of life and self- esteem in children and adolescents: a systematic review and meta-analysis

AIM

To identify the directions, strength and associations between dental anxiety, COHRQoL and self-esteem in children and adolescents.

BASIC RESEARCH DESIGN

PRISMA guidelines were followed and the review registered (PROSPERO CRD42019140037). MEDLINE, Cochrane Library, Scopus, Science Direct, CINAHL, Joanna Briggs Institute (JBI), Grey Literature Report, and British Library EThOS using MeSH terms and keywords were searched. Three reviewers examined the abstracts of all articles, excluded duplicates and those not meeting inclusion criteria. All full-text papers were read by all reviewers. Meta-analysis association data including Pearson's or Spearman's correlation coefficient were extracted and effect sizes estimated.

RESULTS

Twelve papers met the inclusion criteria, 7 assessed the relationship between child dental anxiety and COHRQoL; four between COHRQoL and self-esteem and one between child dental anxiety and self-esteem. Significant relationships were found between COHRQoL and the other child-related outcomes measures. An inverse relationship was shown for dental anxiety and COHRQoL. The meta-analysis found small associations between child dental anxiety and COHRQoL and moderate associations between COHRQoL and self-esteem. High heterogeneity between COHRQoL and self-esteem was noted. The association between child dental anxiety and self-esteem was limited. No source reported associations between all three variables.

CONCLUSION

The studies were of varying quality and the degree of heterogeneity meant that only limited conclusions were possible. There is a need for high-quality evidence to underpin intervention designs to promote COHRQoL and self-esteem to reduce child dental anxiety.

Mode of bond failure between 3D-printed denture teeth and printed resin base material: effect of fabrication technique and dynamic loading. An in-vitro study

PURPOSE

To evaluate the failure load of 3D-printed denture resin material and teeth before and after dynamic loading.

MATERIALS AND METHODS

A total of 40 specimens were fabricated following ISO/TS 19736 and were divided into two equal groups. In the test group, the cylindrical base and denture teeth were 3D printed separately and then luted together. In the control group, the specimens were fabricated from conventional heat-cured polymethyl methacrylate (PMMA) and commercially available denture teeth using the compression-molding technique. Ten specimens from each group were subjected to dynamic load of 50 N for 250,000 cycles in a chewing simulator. All specimens were subjected to static load of 50 N using Instron machine with a crosshead speed of 1 mm/minute until fracture. The fractured surfaces were analyzed using field emission scanning electron microscopy. The failure loads were calculated and compared using analysis of variance (P < .05).

RESULTS

All specimens survived the loading, undergoing 250,000 cycles without fracture. The mean failure load was influenced by fabrication technique and was significantly higher for the 3D-printed test group (P = .028). 3D-printed teeth showed a mixed mode of fracture, whereas in the control group, the specimens showed cohesive fracture within the teeth.

CONCLUSION

The fabrication technique has an influence on the mode of failure between acrylic teeth and resin base material. Cohesive failure in teeth was predominant in the conventional group, suggesting possibly higher bond strength between the teeth and resin base in this group. The observed failure modes reveal that both fabrication techniques exhibited satisfactory bond strength. Chewing simulation did not significantly influence the bond strength of any of the tested groups.

Melioidosis: Case reports of confirmed Burkholderia pseudomallei in Saudi Arabia

Melioidosis is an infectious disease of tropical climates. The disease is caused by the bacterium Burkholderia pseudomallei. Most cases are diagnosed in southeast Asia and northern Australia. Some imported cases diagnosed in returning tourists, soldiers, and immigrants from endemic areas. It caught much attention since the Centers for Disease Control and Prevention (CDC) designated B. pseudomallei as an agent for biological warfare and terrorism. We describe two cases of a 26-year-old Saudi woman who had fulminant sepsis soon after returning from Thailand & a 48-year-old woman with a long history of fever. B. pseudomallei was isolated from both patients blood cultures, and they had different consequences. A confirmed case of melioidosis was not reported before in Saudi Arabia.

The contribution of platelets in the production of cryoprecipitates for use in a fibrin glue

BACKGROUND AND OBJECTIVES

Cryoprecipitate has a wide application for use as a fibrin glue. In some situations, platelets are added to the preparation in order to enhance the fibrin glue.

MATERIALS AND METHODS

Fresh plasma was collected by apheresis from the same donor to produce 250 ml of platelet-rich plasma (PRP) or platelet-poor plasma (PPP) (n = 12 each). Cryoprecipitate was then produced following the standards of the American Association of Blood Banks and resuspended to a total volume of 8 ml, from which aliquots were removed and assayed. Clot formation was measured using the thromboelastogram.

RESULTS

The protein content of the two preparations was identical for PRP and PPP. Results for fibrinogen (PPP 475 +/- 220 mg; PRP 399 +/- 215 mg), Factor VIII (PPP 186 +/- 67 IU; PRP 175 +/- 70 IU) and von Willebrand Factor (PPP 260 +/- 104 IU; PRP 221 +/- 88 IU) were not significantly different. The concentration of platelet-derived growth factor was markedly higher (a 100-fold increase at 3778 +/- 1036 ng) when platelets were added to the plasma. There was a small, but not statistically significant, difference in the rate of clot formation (R = 2.3 for PPP and 3.8 for PRP) and clot strength (MA = 63.4 for PPP and 56.6 for PRP) between PPP and PRP cryoprecipitates when measured using the thromboelastogram.

CONCLUSIONS

Platelets do not significantly increase the concentration of the usual constituents of cryoprecipitate; however, the levels of platelet-derived growth factor are markedly enhanced. Therefore, there are advantages for using PRP to enhance the growth of new tissue.

Automated collection of blood components: their storage and transfusion

The performance of an automated device, the Gambro TRIMA, was evaluated for component production, and an in vivo assessment of the platelets was carried out. Red cell concentrates (RCCs), platelets and plasma were collected and stored according to standard blood bank procedures and evaluated for quality by in vitro measurements. Additionally, single-donor platelets (n=10) were transfused to thrombocytopenic patients after 5 days of storage. Platelet counts were measured after 1 h and the corrected count increment (CCI) was calculated. No significant changes were seen before or after procedure in donor haemoglobin, haematocrit, coagulation factors or platelet count. Return-line samples showed no increase in the level of plasma haemoglobin. Plasma haemoglobin and potassium increased following RBC storage, but there was no change in the red cell number. Platelet aggregation decreased from 52 to 11% (adenosine diphosphate) and the Kunicki morphology score dropped from 379 to 174. Little change was seen in the hypotonic shock response (69-63%) or in the percentage of CD62 expression (4.8-19.8) over time. The CCI averaged 28+/-26 x 10(3) microL(-1) in 10 patients 1 h after transfusion. The TRIMA machine collects RCCs, platelets and plasma in a variety of combinations in one session. For autologous collection, two units of RCC plus platelets can be collected at one time, reducing administrative and testing costs. The platelets have good in vivo recovery, as shown by the CCI values. An added advantage is that the TRIMA machine can be used in hospitals to generate components in times of shortage without the need for a component's laboratory.