Mastalgia: A narrative literature review of current understanding and management

Mastalgia, or breast pain, is one of the most common breast symptoms experienced by women of reproductive age. The cyclical variant of mastalgia is predominant, and patients need proper assessment and management to allay their 2 chief concerns: (1) the severity of pain negatively impacting daily life and (2) the fear of harbouring malignancy. This article presents a brief review of various modalities of management for cyclical mastalgia and emphasizes data collected from peer-reviewed literature published in the last decade. Keywords: mastalgia; breast pain; mastodynia; mammalgia; cyclic mastalgia; noncyclic mastalgia; danazol; tamoxifen; reassurance; visual analogue scale

MERS-CoV transmitted from animal-to-human vs MERSCoV transmitted from human-to-human: Comparison of virulence and therapeutic outcomes in a Saudi hospital

Purpose: To examine virulence (severity of disease and/or symptoms) and response to therapy (medications, supportive measures) between confirmed cases of MERS-CoV animal-to-human transmission compared with cases resulting from human-to-human transmission.Methods: The records for laboratory-confirmed MERS-CoV infections that were diagnosed at King Fahad Hofuf Hospital (Al-Ahsa, Saudi Arabia) from April 1, 2012 to November 30, 2016 were reviewed retrospectively.Results: There were 107 laboratory-confirmed MERS-CoV cases. Transmission of the virus from animal-to-human was less common (21.4 vs 78.6 %). The human-to-human transmission group had a higher mortality rate (53.57 vs 39.13 %). Patients in this group also had higher APACHEE II (11.2 vs 23, p = 0.043), SOFA scores (10.9 vs 12.55, p = 0.076), and higher rates of sepsis (17.39 vs 26.19 %, p = 0.582) and septic shock (13.04 vs 20.23 %, p = 0.555). The infections were more severe in the humanto- human transmission group; patients had increased rates of intensive care unit (ICU) admission (43.47 vs 51.19 %), decreased time from symptom onset until ICU admission, and greater need for mechanical ventilation (8 days vs 4 days, p = 0.041, and 6 days vs 4 days, respectively), longer time to respond to antiviral treatment and resolve the infection (5 days vs 11 days and 7 days vs 13 days, respectively) and a shorter time from the beginning of symptoms until death (11 days vs 5 days, p = 0.048).Conclusion: MERS-CoV transmitted from human-to-human was more virulent, resulted in higher casemortality rates and required more ICU treatment.Keywords: Animal-to-human, Human-to-human, MERS-CoV, Outcomes, Primary infection, Secondary infection, Virulenc

Prevalence and predictors of seizure in patients with Alzheimer’s disease at a tertiary care center in Riyadh, Saudi Arabia

Purpose: To assess the prevalence and predictors of seizures in patients with Alzheimer’s disease (AD) at a Saudi tertiary hospital.Methods: A retrospective, matched case-control study was conducted using the electronic medical records of patients with AD who had an unprovoked seizure, from October 2015 to May 2018.Results: Nineteen cases and 195 controls were identified. Statistically significant risk factors for an unprovoked seizure in patients diagnosed with AD were hypertension (p = 0.001), autoimmune disease, stroke and TIA (p = 0.001). The multivariate logistic regression analysis identified hypertension (OR = 2.89; p = 0.009) and autoimmune disease (OR = 19.6; p = 0.045) as predictors of unprovoked seizure in AD patients.Conclusion: The occurrence of unprovoked seizures is more likely in severe cases of AD. In addition, the risk of seizure in patients with AD increases with two co-morbid conditions, hypertension, and autoimmune disease. However, further studies are required to determine the underlying mechanism of the association between the two risk factors and AD

Cavitation phenomenon in mechanical prosthetic valves: Not only microbubbles

Introduction: Microbubbles (MBs) or cavitation is high-velocity, echo-bright findings present during the closing or opening of a mechanical valve (MVP). Cavitation bubble growth or gas emboli are less frequently described. We evaluated the hemodynamic parameters involved in the formation of gas emboli and the impact of gas emboli on requests for additional investigations. Methods and Results: Transthoracic echocardiographic studies (TTE) of 57 patients (31 males, mean age 46.8\ua0\ub1\ua013.8\ua0years) with gas emboli were evaluated after heart valve replacement surgery. The majority (72%, n\ua0=\ua042) had a mitral or combined mitral/aortic MVP, with 28% (n\ua0=\ua016) an aortic MVP. The last TTE with and without gas emboli were considered for the same patient and the no emboli group was the control group (42 patients). The patient's blood pressure (BP) and heart rate (HR) were available for each TTE. Comparing the two TTEs, the systolic and diastolic BP, transmitral and aortic gradients, and left ventricular ejection fraction were similar but the HR (80.9\ua0\ub1\ua018.7 vs 72.5\ua0\ub1\ua013.9\ua0bpm, P\ua0=.02) was significantly higher in the group with gas emboli. A TEE was performed 52 times in 27 patients, due to gas emboli, with one case positive for thrombus/vegetation. For 19 patients, a brain CT was requested. In two patients, the indication for the brain CT was gas emboli but the result was negative. Conclusion: Gas emboli are frequently present and associated to an increased HR. They can cause the misdiagnosis of endocarditis or thrombus formation with significant additional requests for diagnostic examinations

Evaluation of bi-lateral co-infections and antibiotic resistance rates among COVID-19 patients

In addition to the pathogenesis of SARS-CoV-2, bacterial co-infection plays an essential role in the incidence and progression of SARS-CoV-2 infections by increasing the severity of infection, as well as increasing disease symptoms, death rate and antimicrobial resistance (AMR). The current study was conducted in a tertiary-care hospital in Lahore, Pakistan, among hospitalized COVID-19 patients to see the prevalence of bacterial co-infections and the AMR rates among different isolated bacteria. Clinical samples for the laboratory diagnosis were collected from 1165 hospitalized COVID-19 patients, of which 423 were found to be positive for various bacterial infections. Most of the isolated bacteria were Gram-negative rods (n = 366), followed by Gram-positive cocci (n = 57). A significant association (p 50% of COVID-19 patients were fever, fatigue, dyspnea and chest pain with a significant association (p < 0.05) in bacterial co-infected patients. The current study results showed a comparatively high prevalence of AMR, which may become a severe health-related issue in the future. Therefore, strict compliance of antibiotic usage and employment of antibiotic stewardship programs at every public or private institutional level are recommended

Clinical Characteristics of Non-Intensive Care Unit COVID-19 Patients in Saudi Arabia: A Descriptive Cross-sectional Study

Introduction: The ongoing pandemic of the coronavirus disease 2019 (COVID-19) is a global health concern. It has affected more than 5 million patients worldwide and resulted in an alarming number of deaths globally. While clinical characteristics have been reported elsewhere, data from our region is scarce. We investigated the clinical characteristics of mild to moderate cases of COVID-19 in Saudi Arabia. Methods: This is a descriptive, cross-sectional study. Data of 401 confirmed COVID-19 patients were collected from 22 April 2020 to 21 May 2020 at five tertiary care hospitals in Riyadh, Saudi Arabia. The patients were divided into four groups according to age, Group 1: 0-60 years; and their clinical symptoms were compared. Results: The median (IQR) age in years was 10.5 (1.5-16) in group I, 34 (29-41) in group II, 53 (51-56) in group III, and 66 (61-76) in group IV. Most patients were male (80%, n = 322) and of Arabian or Asian descent. The median length of stay in the hospital was 10 (8-17) days (range 3-42 days). The most common symptoms were cough (53.6%), fever (36.2%), fatigue (26.4%), dyspnea (21.9%), and sore throat (21.9%). Hypertension was the most common underlying comorbidity (14.7%), followed by obesity (11.5%), and diabetes (10%). Hypertensive patients were less likely to present with shortness of breath, cough, sputum, diarrhea, and fever. Conclusion: There was no significant difference in the symptoms among different age groups and comorbidities were mostly seen in the older age group. Interestingly, hypertensive patients were found to have milder symptoms and a shorter length of stay. Further larger collaborative national studies are required to effectively understand clinical characteristics in our part of the world to efficiently manage and control the spread of SARS-CoV-2

Clinical, epidemiological, and laboratory characteristics of mild-to-moderate COVID-19 patients in Saudi Arabia: an observational cohort study

Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged from China in December 2019 and has presented as a substantial and serious threat to global health. We aimed to describe the clinical, epidemiological, and laboratory findings of patients in Saudi Arabia infected with SARS-CoV-2 to direct us in helping prevent and treat coronavirus disease 2019 (COVID-19) across Saudi Arabia and around the world. Materials and methods Clinical, epidemiological, laboratory, and radiological characteristics, treatment, and outcomes of pediatric and adult patients in five hospitals in Riyadh, Saudi Arabia, were surveyed in this study. Results 401 patients (mean age 38.16 ± 13.43 years) were identified to be SARS-CoV-2 positive and 80% of cases were male. 160 patients had moderate severity and 241 were mild in severity. The most common signs and symptoms at presentation were cough, fever, fatigue, and shortness of breath. Neutrophil and lymphocyte counts, aspartate aminotransferase, C-reactive protein, and ferritin were higher in the COVID-19 moderate severity patient group. Mild severity patients spent a shorter duration hospitalized and had slightly higher percentages of abnormal CT scans and X-ray imaging. Conclusions This study provides an understanding of the features of non-ICU COVID-19 patients in Saudi Arabia. Further national collaborative studies are needed to streamline screening and treatment procedures for COVID-19

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Effectiveness of the Boston University predental postbaccalaureate program on dental school academic performance

PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact [email protected] (DScD) --Boston University, Henry M. Goldman School of Dental Medicine, 2011 (Department of Health Policy and Health Services Research).Includes bibliographic references: leaves 113-118.The need for diversity in the health care professions raised the opportunity for many medical and dental schools to develop postbaccalaureate (postbac) programs as one tool to help remedy this situation. However, few studies have addressed the effectiveness of these postbac programs, with most research focused on premedical postbac programs. The purpose of this study is to evaluate the effectiveness of the Masters of Art in Medical Sciences-Oral Health track program (MAMS-OH) in enhancing predental postbac students' academic credentials when pursuing their dental school training. Our study sample included 448 graduating BUGSDM DMD students (DMD10-DMD13). Academic performance indicators for the MAMS-OH postbac students who entered Boston University Henry M. Goldman School of Dental Medicine (BUGSDM) were compared to their traditional counterparts in the DMD program who had not undergone any additional postbac training. Comparisons were also performed with a third group of 'other' graduate degree students. Results of our bivariate, bootstrap, and multivariate analysis all confirmed that there were no differences between DMD groups for their first year dental school GPA. Differences were found between groups for second year dental school performance, where MAMS-OH postbac students had lower GPAs (3.2/B+) than traditional DMD (3.4/B+) and 'other' graduate degree students (3.4/B+) (P-value=0.0001). However, there were no differences in 3rd year GPA, 4th year GPA, dental school retention, or for passing the NBDE part I. The best predictors of academic achievement in pre-clinica1 1st and 2nd years of dental school included undergraduate preadmission indicators. In contrast, the best predictors of clinica1 3rd and 4th years of dental school were having a family member in the field of dentistry and fathers' level of education. Comparisons were also made to determine whether Underrepresented Minorities (URM) performed as well as their dental school counterparts. In general, compared to URM-non-Traditional students, URM MAMS-OH postbac students or URM-traditional DMD students had lower preadmission scores, and lst year and 2nd year dental school performance, however, there were no performance differences by their third year of dental school. The results of this study suggest that the MAMS-OH program had a positive impact on academic performance of predental postbac students while in BUGSDM. Postbac students' acceptance rates into dental school and retention rates while in dental school were high. While in dental school, these students performed comparably to the traditional 'middle of the class' tertile students. BUGSDM predental potbac program offers a valid approach to increasing URM representation and graduation from dental school, which may increase access to dental care for URMs in the future

The Effect of Using Reactive Agility Exercises with the FITLIGHT Training System on the Speed of Visual Reaction Time and Dribbling Skill of Basketball Players

The study aimed to determine the effect of reactive agility with the FITLIGHT training system on the speed of the visual reaction time and dribbling skill of basketball players. Participants were divided into an experimental group (n = 10; age, 14.80 ± 0.79 years; height, 163.80 ± 3.46 cm; weight, 55.90 ± 0.99 kg; training, 4.50 ± 0.53 years) and a control group (n = 10; age, 14.60 ± 0.70 years; height, 163.30 ± 3.47 cm; weight, 56.10 ± 0.74 kg; training, 4.30 ± 0.48 years). Reactive agility was assessed through a modified t-test, visual reaction time was assessed using the Li Lafayette instrument Visual Reaction Time Apparatus 63014 response panel, and dribbling skills were assessed through dribbling testing. The results showed improved agility through the modified agility t-test (11%; p = 0.001), an increased speed of visual reaction time for both the right and left hands (23–31%), and improved dribbling skills (19%; p = 0.001) for the experimental group using the FITLIGHT reactive agility software. The results also showed increased skills of the experimental group when compared to the control group. Differences in variability emerged between 6 and 14.1% in favor of the experimental group. Therefore, the researchers recommended that attention should be paid to activating the role of the FITLIGHT reactive agility training to improve and develop the physical, visual, and skill capabilities of basketball players. The researchers propose that FITLIGHT can be effectively used in the basketball training process