Non-clinical Cases Research Articles

Review on trypanosomiasis and their prevalence in some country on the Red Sea.

Trypanosomiasis is a protozoan infection affecting both human and animals in almost all parts of the world. It can affect a very large range of domestic and wild hosts including camelids, equines, cattle, buffaloes, sheep, goats, pigs, dogs and other carnivores, deer, gazelles and elephants. This review paper was designed to address the effect of this economically important disease in countries on the Red Sea, especially in Egypt, Sudan, Somalia, and Saudi Arabia during the period 2010 to 2020. The prevalence of trypanosomiasis is different between these countries due to different types of diagnostic methods (Giemsa-stained blood smears, Hematocrit centrifugation, Serological test, and molecular analysis PCR) used and differential distribution of vector (Tse tse) flies. In current review, retrospective studies of published literature on distribution and prevalence of Trypanosoma evansi infection in the Red Sea Countries was conducted [Google Scholar and PubMed were used to retrieve the published literature from 2000-2020. A total of 77 published articles met the eligibility criteria and were reviewed. A total of 16 reports have been reported on the prevalence and distribution of Trypnosoma evansi infection in the Red Sea Countries have been from 2010-2020]. According to the published literature, we can say that trypanosomiasis in camels are more prevalent in Sudan than in other countries, followed by 17% and 51.78% in both clinical and non-clinical cases. Hence, the reliable diagnostic tests should be used for rapid treatment or control of the disease as if not treated appropriately in early-stage, can lead to death of the camels.

Benchmark of the PenRed Monte Carlo framework for HDR brachytherapy

PurposeThe purpose of this study is to validate the PenRed Monte Carlo framework for clinical applications in brachytherapy. PenRed is a C++ version of Penelope Monte Carlo code with additional tallies and utilities. Methods and materialsSix benchmarking scenarios are explored to validate the use of PenRed and its improved bachytherapy-oriented capabilities for HDR brachytherapy. A new tally allowing the evaluation of collisional kerma for any material using the track length kerma estimator and the possibility to obtain the seed positions, weights and directions processing directly the DICOM file are now implemented in the PenRed distribution. The four non-clinical test cases developed by the Joint AAPM-ESTRO-ABG-ABS WG-DCAB were evaluated by comparing local and global absorbed dose differences with respect to established reference datasets. A prostate and a palliative lung cases, were also studied. For them, absorbed dose ratios, global absorbed dose differences, and cumulative dose-volume histograms were obtained and discussed. ResultsThe air-kerma strength and the dose rate constant corresponding to the two sources agree with the reference datatests within 0.3% (Sk) and 0.1% (Λ). With respect to the first three WG-DCAB test cases, more than 99.8% of the voxels present local (global) differences within ±1%(±0.1%) of the reference datasets. For test Case 4 reference dataset, more than 94.9%(97.5%) of voxels show an agreement within ±1%(±0.1%), better than similar benchmarking calculations in the literature. The track length kerma estimator scorer implemented increases the numerical efficiency of brachytherapy calculations two orders of magnitude, while the specific brachytherapy source allows the user to avoid the use of error-prone intermediate steps to translate the DICOM information into the simulation. In both clinical cases, only minor absorbed dose differences arise in the low-dose isodoses. 99.8% and 100% of the voxels have a global absorbed dose difference ratio within ±0.2% for the prostate and lung cases, respectively. The role played by the different segmentation and composition material in the bone structures was discussed, obtaining negligible absorbed dose differences. Dose-volume histograms were in agreement with the reference data. ConclusionsPenRed incorporates new tallies and utilities and has been validated for its use for detailed and precise high-dose-rate brachytherapy simulations.

Predictive factors of clinical success after adrenalectomy in primary aldosteronism: A systematic review and meta-analysis.

Unilateral adrenalectomy is the mainstay treatment for unilateral primary aldosteronism (PA). This meta-analysis aimed to systematically analyse predictors of clinical success after unilateral adrenalectomy in PA. A search was performed using PubMed/Medline, Scopus, Embase and Web of Science from their inception to February 2022. Observational studies in adult PA patients which reported predictors of clinical success after unilateral adrenalectomy were included. A random-effects model was employed to pool the fully adjusted odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval (95% CI). Thirty-two studies involving 5,601 patients were included. Females had a higher clinical success rate (OR 2.81; 95% CI 2.06-3.83). Older patients, patients with a longer duration of hypertension and those taking a higher number of antihypertensive medications had lower clinical success rates (OR 0.97; 95% CI 0.94-0.99, OR 0.92; 95% CI 0.88-0.96 and OR 0.44; 95% CI 0.29-0.67, respectively). Compared to non-clinical success cases, patients with clinical success had a lower body mass index (SMD -0.49 kg/m2; 95% CI-0.58,-0.39), lower systolic (SMD -0.37 mmHg; 95% CI -0.56,-0.18) and diastolic blood pressure (SMD -0.19 mmHg; 95% CI -0.33,-0.06), lower serum potassium (SMD -0.16 mEq/L; 95% CI -0.28,-0.04), higher eGFR (SMD 0.51 mL/min/1.73m2; 95% CI 0.16,0.87), a lower incidence of dyslipidemia (OR 0.29; 95% CI 0.15-0.58) and a lower incidence of diabetes mellitus (OR 0.36; 95% CI 0.22-0.59). Multiple predictors of clinical success after unilateral adrenalectomy in PA were identified which can help improve the quality of care for PA patients. Systematic Review Registration: INPLASY, identifier 202240129.

Structural Relationship of Anxious Attachment Style with Pain Catastrophizing, Fear of Pain, and Vigilance to Pain in Non-clinical Pain Cases

Background: The present study aimed to determine the relationship of anxious attachment style with catastrophizing, fear of pain, and hypervigilance. Methods: The study sample consisted of 210 students at Tabriz University, Iran, with recent acute pain or the lack of pain experience selected by the convenience sampling method. The subjects responded to the Relationship Scales Questionnaire, Pain Catastrophizing Scale, Fear of Pain Questionnaire, and Pain Vigilance and Awareness Questionnaire. Data were analyzed by Pearson’s correlation coefficient and structural equation modeling. Results: The findings indicated a significant positive relationship between the subscale of anxious attachment and the variables of catastrophizing, fear of pain, and vigilance to pain, as well as a relationship among the variables. Moreover, the modeling showed a structural relationship between anxious attachment and studied variables. Conclusions: Anxious attachment style acts as a vulnerability factor and a predictor of chronic pain in individuals without pain experience. It means that facing catastrophic pain in people with anxious attachment styles can lead to the fear of pain and hypervigilance.

Cortical signature related to psychometric properties of pain vigilance in healthy individuals: A voxel-based morphometric study

The Pain Vigilance and Awareness Questionnaire (PVAQ) is a questionnaire for non-clinical and clinical cases of patients, such as those suffering from chronic pain. Moreover, it is used for evaluation of two aspects of habitual attention to pain: attention to pain and attention to changes in pain. As the PVAQ assesses two different aspects of attention function, different neural basis may present. However, it remains unclear which brain regions are involved. Here, we performed voxel-based morphometry (VBM) in 30 healthy participants to determine the regional morphology associated with the two attention states. Multiple regression analysis was conducted between each score and the regional grey matter (GM) volume, which revealed that a decreased GM volume in the left anterior insular cortex (AIC) was associated with a higher attention to pain score. In contrast, no brain region was correlated with the attention to changes in pain score. Our VBM results demonstrate that attention to pain scores assessed by PVAQ are associated with morphological features of the left AIC. Moreover, they may contribute to the elucidation of the complex psychological and neurophysiological characteristics of patients with chronic pain.

Assessment Tool of Bipolar Disorder for Primary Health Care: The SAEBD.

Mixed states are highly prevalent in patients with bipolar disorder and require comprehensive scales. Considering this, the current study aims to develop a measure to assess the full spectrum of clinical manifestations of bipolar disorder. A sample of 88 patients was evaluated; the Hamilton Depression Scale (HAM-D), Montgomery-Asberg Depression Scale (MADRS), and the Young Mania Rating Scale (YMRS) were applied, together with the preliminary version of the Scale for the Assessment of Episodes in Bipolar Disorder (SAEBD). After analyzing the appropriateness and statistical properties of the items, discriminant analysis and analysis of diagnostic capacity were performed. The discriminant functions correctly classified 100% of the cases in euthymia, predominant depressive symptoms or mixed symptoms, as well as 92.3% of the cases with predominant manic symptoms. Overall, the functions correctly classified 98.9% of the cases. The area under the curve (0.935) showed high capacity to discriminate between clinical and non-clinical cases (i.e., in euthymia). The SAEBD sensitivity was 0.95, specificity was 0.71, the Positive Predictive Value (PPV) was 0.88, the Negative Predictive Value (NPV) was 0.87, the Positive Likelihood Ratio (+LR) was 3.33, and the Negative Likelihood Ratio (−LR) was 0.07. In conclusion, the SAEBD is a promising scale that shows high reliability and validity, as well as diagnostic utility as a screening tool for use in diverse health care settings.

Psychometric properties of the Intolerance of Uncertainty Scale-12 in generalized anxiety disorder: Assessment of factor structure, measurement properties and clinical utility

Intolerance of uncertainty is a psychological vulnerability implicated in the development and maintenance of generalized anxiety disorder (GAD). The Intolerance of Uncertainty Scale-12 (IUS-12) is a widely used measure, however no studies have thoroughly tested the psychometric properties in a clinically diagnosed GAD sample. This study aimed to evaluate the factor structure, measurement properties and clinical utility of the IUS-12 in clinical and non-clinical samples. Participants were screened using the Anxiety Disorders Interview Schedule for DSM-IV to ascertain clinical (n = 136: principal diagnosis of GAD) or non-clinical status (n = 76). Confirmatory factor analysis determined that the bifactor type (two-factor testlet) model demonstrated significantly better fit in comparison to the unidimensional model for the clinical sample. The IUS-12 exhibited limited multidimensionality indicating that only the total score provides meaningful interpretation. The IUS-12 demonstrated good construct validity (with DASS-21, MCQ-30, and PSWQ), good internal consistency, as well as good test-retest reliability over 12-weeks. The IUS-12 demonstrated responsivity to treatment following cognitive behavioral therapy and mindfulness based psychological interventions. Receiver operating characteristic curve analysis indicated an optimal cut-off score of 28 for distinguishing individuals with GAD from non-clinical cases. Overall, the IUS-12 is a valid, reliable and clinically useful instrument for individuals with GAD.

Attentional Bias and Prediction of Attempted Suicide in Clinical and Non-clinical Population

Objective: the aim of the present research was to analyze the predictability of suicide attempts, based on attentional bias in a clinical and non-clinical population. Methods: 120 participants (77 females and 43 males) were intentionally selected in three diagnostic groups: clinical suicides, clinical non-suicides, and non-clinical ones (40 individuals in each group). They participated in the Suicide Stroop Task as well as the Beck Scale of Suicide Ideation (BSS). The attentional bias parameters, including reaction time and interference time, were computed and the data were analyzed using Multivariate Analysis of Variance and Discriminant Analysis. Results: the results obtained from the multivariate analysis revealed that the variables of interference time did not have a significant indication for the three groups of individuals in suicide stroop (P<0.568; F=0.569), positive stroop (P<0.201; F=1.626), and negative stroop (P<0.863; F=0.147). However, in the case of reaction time, there was a significant difference in the values obtained for all the three groups in terms of suicide stroop (P<0.000; F=12.759), positive stroop (P<0.000; F=18.520), negative stroop (P<0.000; F=10.995), and neutral stroop (P<0.000; F=8.288). In addition, the results obtained from the discriminant analysis show that the variables of suicide ideation (0.822), reaction time in positive stroop (0.571), suicide stroop (0.470), negative stroop (0.438), and neutral stroop (0.376) were correspondingly crucial in predicting the behavior of the clinical suicide attempt, clinical non-suicide attempt, and non-clinical groups. Conclusion: We found that for suicide stroop, the clinical and non-clinical cases did not show a significant difference in terms of the interference effect; however, they differed in terms of reaction time. Therefore, it seems that using emotional stroop, attentional bias towards suicide-related topics is not dependent on the clinical situations, and other parameters, such as scoring methods should be considered. However, there is still a need to conduct more extensive studies.

These confabulations are guaranteed to improve your marriage! Toward a teleological theory of confabulation

Confabulation is typically understood to be dysfunctional. But this understanding neglects the phenomenon’s potential benefits. In fact, we think that the benefits of non-clinical confabulation provide a better foundation for a general account of confabulation. In this paper, we start from these benefits to develop a social teleological account of confabulation. Central to our account is the idea that confabulation manifests a kind of willful ignorance. By understanding confabulation in this way, we can provide principled explanations for the difference between clinical and non-clinical cases of confabulation and the extent to which confabulation is rational.

Identification of the ABCC4, IER3, and CBFA2T2 candidate genes for resistance to paratuberculosis from sequence-based GWAS in Holstein and Normande dairy cattle

BackgroundBovine paratuberculosis is a contagious disease, caused by Mycobacterium avium subsp. paratuberculosis (MAP), with adverse effects on animal welfare and serious economic consequences. Published results on host genetic resistance to MAP are inconsistent, mainly because of difficulties in characterizing the infection status of cows. The objectives of this study were to identify quantitative trait loci (QTL) for resistance to MAP in Holstein and Normande cows with an accurately defined status for MAP.ResultsFrom MAP-infected herds, cows without clinical signs of disease were subjected to at least four repeated serum ELISA and fecal PCR tests over time to determine both infected and non-infected statuses. Clinical cases were confirmed using PCR. Only cows that had concordant results for all tests were included in further analyses. Positive and control cows were matched within herd according to their birth date to ensure a same level of exposure to MAP. Cows with accurate phenotypes, i.e. unaffected (control) or affected (clinical or non-clinical cases), were genotyped with the Illumina BovineSNP50 BeadChip. Genotypes were imputed to whole-genome sequences using the 1000 Bull Genomes reference population (run6). A genome-wide association study (GWAS) of MAP status of 1644 Holstein and 649 Normande cows, using either two (controls versus cases) or three classes of phenotype (controls, non-clinical and clinical cases), revealed three regions, on Bos taurus (BTA) chromosomes 12, 13, and 23, presenting significant effects in Holstein cows, while only one of those was identified in Normande cows (BTA23). The most significant effect was found on BTA13, in a short 8.5-kb region. Conditional analyses revealed that only one causal variant may be responsible for the effects observed on each chromosome with the ABCC4 (BTA12), CBFA2T2 (BTA13), and IER3 (BTA23) genes as good functional candidates.ConclusionsA sequence-based GWAS on cows for which resistance to MAP was accurately defined, was able to identify candidate variants located in genes that were functionally related to resistance to MAP; these explained up to 28% of the genetic variance of the trait. These results are very encouraging for efforts towards implementation of a breeding strategy aimed at improving resistance to paratuberculosis in Holstein cows.

Persistent depressive disorder across the adult lifespan: results from clinical and population-based surveys in Germany

BackgroundAlthough the individual and economic disease burden of depression is particularly high for long-term symptoms, little is known of the lifetime course of chronic depression. Most evidence derives from clinical samples, and the diagnostic distinction between persistent depressive disorder (PDD) and non-chronic major depression (NCMDD) is still debated. Thus, we examined characteristics of PDD among clinical vs. non-clinical cases, and the associated disease burden at a population level.MethodsData were drawn from the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009–2012, n = 4483) and a clinical sample of PDD inpatients at Charité – Universitätsmedizin Berlin (2018–2019, n = 45). The DSM-5 definition of PDD was operationalized a priori to the study using interview-based DSM-IV diagnoses of dysthymia and major depression lasting at least 2 years in both surveys. Additional depression characteristics (depression onset, self-classified course, suicidality, comorbid mental disorders, treatment history and current depressive symptoms [Patient Health Questionnaire-9]) were assessed. In the DEGS1-MH, health-related quality of life (Short Form Health Survey-36, SF-36), chronic somatic conditions, number of sick days (past 12 months) or days with limitations in normal daily life activities (past 4 weeks), and health service utilization (past 12 months) were compared for PDD vs. NCMDD.ResultsPDD cases from the clinical sample had a significantly earlier depression onset, a higher proportion of self-classification as persistent course, and treatment resistance than PDD and NCMDD cases in DEGS1-MH. At a population level, PDD cases showed worse outcomes compared with NCMDD cases in terms of somatic comorbidity, SF-36 mental component score, and activity limitations owing to mental health problems, as well as a higher risk for outpatient mental health care contact.ConclusionsThe distinction between PDD and NCMDD proposed for DSM-5 seems warranted. Early onset depression, self-classification as persistent depressive course, and treatment resistance are suggested as markers of more severe and chronic depression courses. At a population level, PDD is associated with remarkably higher individual and economic disease burden than NCMDD, highlighting the need to improve medical recognition of chronic courses and establish specific treatment concepts for chronic depression.

GDC proposals to allow more time to respond to allegations 'must be extended to non-clinical cases'

GDC proposals to allow more time to respond to allegations 'must be extended to non-clinical cases'

Characterization of serotonin following exposure to antibiotics in white-tailed deer

Developing baseline concentrations of serotonin in healthy white-tailed deer will allow for the development of a biomarker using non-invasive sample tissues in sick animals, for example, non-clinical cases of chronic wasting disease. It will also allow some further insight into whether the use of antibiotics as growth promoters (AGP), such as chlortetracycline, is affecting serotonin concentrations in white-tailed deer. Florfenicol and tulathromycin impacts on serotonin concentration changes were also investigated. An analytical method for the detection and confirmation of serotonin, 5-hydroxytryptamine (5-HT), in white-tailed deer tissues was developed and validated. Serum and urine samples were extracted with acetonitrile. Liquid chromatography separation was attained on a Phenomenex C18 column with a Security Guard ULTRA guard column with gradient elution using a mobile phase of 0.1% formic acid in water and 0.1% formic acid in acetonitrile. This methodology was applied to baseline (control), chlortetracycline (CTC) treated, florfenicol treated and tulathromycin treated white-tailed deer serum and urine samples.

Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease

Background: Alice in Wonderland syndrome (AIWS) is a rare neurological disorder characterized by distortions of visual perception (metamorphopsias), the body image, and the experience of time, along with derealization and depersonalization. Some 85% of patients present with perceptual distortions in a single sensory modality, e.g., only visual or only somesthetic in nature. Moreover, the majority experience only a single type of distortion, e.g., only micropsia or only macropsia. AIWS has many different etiologies, and hence an extensive differential diagnosis. Its amenability to treatment depends on the underlying pathological process, which in children is mostly encephalitis, and in adults, migraine. In the literature, no more than 180 “clinical” cases of AIWS have been described (i.e., cases in need of medical attention). Of them, some 50% showed a favorable prognosis. However, non-clinical cases (i.e., fleeting, transient cases of AIWS for which no professional help is needed) have been described in up to 30% of the general population. This indicates that AIWS is perhaps not as rare as traditionally assumed, and has led some authors to conclude that, prognostically, AIWS is usually harmless.Methods: From our own clinical practice, we describe the first known case of Creutzfeldt-Jakob Disease (CJD, Heidenhain variant) that presented with symptoms of AIWS.Results: In our patient, disease onset was sudden and rapidly progressive, starting with isolated visual symptoms. Symptoms of AIWS comprised akinetopsia, chloropsia, micropsia, macropsia, zoom vision, and time distortions (quick-motion phenomenon and protracted duration). Soon, these were complicated by paraesthesias, gait instability, aphasia, expressive amusia, cognitive decline, and behavioral changes in the form of agitation and emotional lability. The diagnosis of probable sporadic CJD was confirmed with the aid of a head MRI and cerebrospinal fluid (14-3-3 protein). In the absence of any treatment options, our patient was discharged home and died within 2 months after his visual symptoms had begun. Autopsy consent was not obtained.Conclusion: We conclude that AIWS is not always as harmless as sometimes suggested, and that CJD, although extremely rare, must be part of its extensive differential diagnosis, notably in the presence of rapid cognitive decline.

Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012.

BackgroundIn 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of <50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates.MethodsMaternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates.ResultsThe estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57–0.81%) resulting in a global CS rate of 473 (385–561) per 100,000 live births and 661,000 (538,000–784,000) total CS cases, including 355,000 (290,000–419,000) adverse birth outcomes (ABO) and 306,000 (249,000–363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs– 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63–0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000–432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment.ConclusionsCongenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.

Impact of foot-and-mouth disease on fertility performance in a large dairy herd in Kenya

This was a retrospective cohort study using data collected from a large-scale dairy herd in Kenya (n = 328 female animals), to investigate the effects of foot-and-mouth disease (FMD) on herd fertility performance following a confirmed outbreak in a regularly vaccinated herd. Kaplan-Meier graphs were used to depict differences in survival functions between exposure groups and Cox regression models were used to calculate hazard ratios (HR) for associations between being clinical FMD cases and the following fertility outcomes: age at first calving; fertility failure related culling (not in calf); time to first service; time to conception. Potential confounding variables investigated and controlled for were age, breed, parity, stage of lactation/gestation and eligibility for service. A case control study was nested within the cohort to investigate the effects of disease on conception HR following calving by comparing animals susceptible to fertility suppression at the time of the outbreak (cases) to animals that had conceived prior to the outbreak (controls).The median age of first calving in clinically affected young-stock was 2.7 months higher than non-clinical cases (adjusted HR = 0.37, 95%CI 0.21–0.67, P = 0.01). There was no evidence of a difference in fertility related culling and times to first service and conception. Animals susceptible to fertility suppression at the time of the outbreak had a lower hazard of conception compared to animals served prior to the outbreak (HR = 0.56, 95%CI 0.41–0.75, P = 0.01). Within the herd, the odds of being a case decreased with parity and age likely related to the lifetime number of vaccination doses received which may reduce the impact among older animals in the herd. Moreover, one would expect the impact to be higher in a non-vaccinating herd to be higher. Notwithstanding these limitations, the results of this study provide evidence that FMD outbreaks in endemic settings impact herd fertility performance. An increased age at first calving is likely to increase rearing costs and reduce an animal’s lifetime productivity while poorer conception rates will likely extend calving intervals. Impaired herd fertility and production will incur higher costs to the farmer and society as animals are less productive which for FMD can extend beyond the outbreak period where economic studies tend to focus. These impacts of FMD on herd fertility should be considered when conducting benefit-cost analyses of FMD control to inform resource allocation.

The Relationship between Internet Addiction and Internalizing Problems in Overweight/Obese Adolescents: A Moderated Mediation Model

To explore the relationship of Internet addiction, coping styles, stressful life events and internalizing problems in overweight/obese adolescents, this research surveyed 1438 middle school students among which 245 overweight and obesity (non-clinical cases) were screened based on the body mass index (BMI) percentile criteria of Working Group on Obesity in China (WGOC) by a series of questionnaires and anthropometric indices. The results indicated as follows: (1) Negative coping styles played a partial mediating role in the relationship between Internet addiction and internalizing problems among overweight/obese adolescents, which means Internet addiction had a direct effect on internalizing problems and also indirectly affected internalizing problems through negative coping styles. (2) The mediating effect of negative coping styles was moderated by stressful life events. The effect of negative coping styles on internalizing problems was in positive proportion to internalizing problems. Internet addiction, coping styles, stressful life events and internalizing problems among overweight/obese adolescents constructed a moderated mediating model. [N A J Med Sci. 2017;10(4):139-147. DOI: 10.7156/najms.2017.1004139]

Lumpy skin disease in cattle: Frequency of occurrence in a dairy farm and a preliminary assessment of its possible impact on Egyptian buffaloes.

Lumpy skin disease (LSD) is an endemic infectious disease of cattle in Egypt. This survey aimed to define the prevalence of clinical and sub-clinical LSD virus (LSDV) infection among cattle and investigate their contact with water buffaloes (Bubalus bubalis) in order to improve the understanding of LSD epidemiology. Cattle and buffalo were examined owing to the appearance of skin lesions. Because clinical signs were consistent with LSDV infection, samples from cattle in a non-grazing dairy farm (n = 450) were submitted for LSDV testing together with those from the in-contact buffaloes (n = 100). Results revealed that the intra-herd percentage of cattle infected with LSDV varied with the detection method. This ranged from 22.4% to 65.4% by virus isolation (VI) and polymerase chain reaction (PCR), respectively, in clinical cattle samples, compared to 0% and 10% by VI and PCR in non-clinical cases. Using the neutralising index (NI), LSDV antibodies were found in 100% (n = 100) of the tested cow’s sera (NI = > 2.0 and ≥ 3.0), whereas buffalo’s sera (n = 34) displayed little increase in antibody level (NI ≥ 1.5). None of the buffalo were positive for LSDV by VI and PCR. In addition, there were no significant differences in LSD prevalence among the cattle with regard to age and sex. In conclusion, the occurrence of LSD in cattle warrants a further epidemiological study of the spread of the disease in the area and adoption of control and prevention strategies. In addition, the PCR assay was confirmed to be useful in the diagnosis of LSDV and for wider epidemiological studies.

Heart rate variability in cases of orthostatic dysregulation of undetermined subset during the new standing test

Orthostatic dysregulation (OD) and its specific subset is diagnosed employing the new standing test. We have previously observed that the pattern of the LF/HF (LF:0.04–0.15 Hz, HF: 0.15–0.4 Hz) ratio as an index of heart rate variability during the standing test reflects differences among the subsets of orthostatic dysregulation. The peak LF/HF for instantaneous orthostatic hypotension (INOH) increases at a late stage during standing, whereas that for postural tachycardia syndrome (POTS) does so in the early stage. In the present study we analyzed the LF/HF pattern in 48 cases of OD in which the subset had not been determined by the new standing test, although 33 of those cases were of clinical orthostatic dysregulation. Among the 48 cases, the LF/HF pattern was INOH in 17, POTS in 8, POTS with an INOH pattern in 7, NMS (neurally mediated syncope) in 2, and normal in 14. In the clinical OD cases, the LF/HF pattern was INOH in 12, POTS in 7, POTS with an INOH pattern in 6, and NMS in 2. Among the non-clinical orthostatic dysregulation cases, 7 showed a normal LF/HF pattern. There were several orthostatic dysregulation cases for which the subset could not be determined by the new standing test alone. By including the LF/HF pattern with the new standing test, it may be possible to improve the accuracy of the orthostatic diagnosis.

Monitoring Incident Reporting To Improve Quality And Patient Safety : Sharing Malaysia Experience

Hospital A monitor 17 types of incidents using incident reporting form. The form will be submitted to the Quality unit and the in charge of that unit will decide whether RCA is necessary or not based on the types of incidents by rating from level 1 (low risk) to level 4 (extreme risk).The RCA committee will investigate the incidence and come out with the conclusion and recommendations for further action by related parties. In order to ensure a good compliance among staff and doctors in this hospital, continuous briefing and teaching were conducted. Data collected will be tabulated on monthly basis and analysis will be done on yearly basis. Comparison of the trending was done between year 2014 and year 2015. For the whole year of 2014, there were 63 cases of clinical incidents reported but reduced to 48 cases in 2015. For non-clinical cases in 2014 there were 9 cases reported which increased to 11 cases in 2015.The most significant reduction of cases was related to OSH related events which reduced from 9 cases in 2014 to 2 cases in 2015. Departure from best clinical practice had recorded 10 cases in 2014 but no case was reported in 2015.Other incidents had not shown a very significant reduction in number of cases from 2014 to 2015.Policy changes were implemented from the following cases:Patient fall which had shown a reduction of cases from 16 in 2014 to 11 cases in 2015; Medication error where changes of policies were done for both pharmacy and nursing services and cases had reduced from 14 cases in 2014 to 12 cases in 2015 and Sentinel event in 2015, where the Management had raised the height of fence at the second floor. There was no change in policies for other types of incidents. Monitoring of incidents had enabled the Management of Hospital A to improve the quality of care and increase