Search

* Context.--Monoclonal gammopathy of renal significance (MGRS) is a relatively new concept for patients with renal monoclonal protein deposition (RMPD) (except monoclonal cast nephropathy) and has been used as a reason for nephrologists to obtain a bone marrow biopsy (BMB). It takes a team of pathologists and clinicians to determine when RMPD at our institution can be defined as MGRS. Objective.--To identify the proportion of various subtypes of tentative MGRS diagnosed by renal biopsy that can be confirmed as final MGRS after BMB. Design.--One hundred thirty kidney biopsies with variants of RMPD were identified during the past 10 years. Biopsy cases with known myeloma, B-cell lymphoma, or monoclonal cast nephropathy were separated as a heavy-burden group. The remaining biopsies with RMPD were considered tentative MGRS. Their BMB and clinical indices were further analyzed to determine the final percentage of MGRS diagnoses. Results.--Among the 130 renal paraprotein deposition cases, 44 (33.8%) were categorized as the heavy-burden group. In the remaining 86 cases, 33 (38.4%) with subsequent identification of myeloma (>10% of monoclonal plasma cells) or lymphoma in BMB were further considered as heavy-burden cases. Eighteen cases (18 of 86; 20.9%) did not receive follow-up BMB; thus, no further analysis was performed. BMBs diagnosed as either nonmalignant (no plasma cells; 8 of 86 cases; 9.3%) or premalignant ( Conclusions.--The data indicate that BMB is an important element in the confirmation of MGRS., Myeloma occurs mainly in elderly individuals. The mean ages for men and women to develop multiple myeloma are 67 and 70 years old, respectively. (1,2) Older individuals often have other [...]

Academic life in the present era is subject to several occupational stressors, including increased workloads, reduced research funding, tenuous career paths, and family-work conflicts. Such stressors affect academics’ quality of life, wellbeing, and job satisfaction, and women are particularly vulnerable. There is, however, a dearth of information on such issues in the Arab World. We conducted a scoping review to map the current body of knowledge related to the institutional and socio-cultural factors that influence the wellbeing status of women working in academia in Arab countries. Fourteen articles were included. Several challenges threatening women’s wellbeing in academia were identified including institutional factors (i.e., human resource policies and laws, workplace empowerment, and academic mentoring) and socio-cultural factors (i.e., work-life balance, culture and religion). Current human resources, policies, and labor laws do not adequately support maternal or complex family roles contributing to work-life imbalances and contribute to poor mental health outcomes for academic women working in academia in Arab countries. Although some of these challenges may stem from lingering cultural stereotypes about gender roles, this review highlights the need for professional development and mentoring programs for academic women in Arab countries, in addition to supportive institutional laws, policies, and resources for empowerment of women in academia.

Abstract Background The COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties. Methods This is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period. Results There were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41–0.64), 27% (0.73, 0.55–0.99), 46% (0.54, 0.30–0.99), 40% (0.60, 0.39–0.92) and 59% (0.41, 0.29–0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52–1.01), oncology (0.71, 0.48–1.05), trauma (0.90, 0.63–1.28) and vitreoretinal (0.67, 0.42–1.08) categories. Conclusion This study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.

Wafa Elhag,1,2 Bahaeldin K Elamin,1,3 Ebtehal Idris,4 Azza Elsheikh,1 Khaled Ghaleb,4 Ibtihal Fallatah,5 Doaa Hassan,5 Mahmoud Elkhalifa,5 Ehssan Moglad,6 Ali Eleragi1 1Department of Basic Medical Sciences (Microbiology Unit), College of Medicine, University of Bisha, Bisha, Saudi Arabia; 2Microbiology Department, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan; 3Department of Microbiology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan; 4Medical Laboratories Department, College of Applied Medical Sciences, University of Bisha, Bisha, Saudi Arabia; 5Laboratory and ICU (Medical Department) King Abdullah Hospital-Bisha, Bisha, Saudi Arabia; 6Department of Pharmaceutics, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi ArabiaCorrespondence: Wafa Elhag, Department of Basic Medical Sciences (Microbiology Unit), College of Medicine, University of Bisha, P.O.Box 1290, Bisha, 61922, Saudi Arabia, Email welhag@ub.edu.saBackground: Understanding COVID-19’s onset and clinical effects requires knowing host immune responses.Objective: To investigate the presence of IgM, IgG, and cytokine levels (IL-2 and IL-6) in individuals with COVID-19 who have had their diagnosis confirmed by PCR.Methods: This cross-sectional research included 70 adult ICU patients from King Abdullah Hospital in Bisha, Saudi Arabia. Subjects gave two blood samples. After hospital release, only 21 patients provided the second sample. Each patient provided a sample upon admission. Quantitative ELISAs evaluated IL-2, IL-6, and SARS-CoV-2-specific IgM and IgG antibodies.Results: All patients were critically ill and unvaccinated against COVID-19. 46 (65.7%) of the patients were male, and their age range was 33– 98 years (with a mean age of 66.5); 24.3%) were 51– 61 years old. IgG was positive in all patients, although IgM predominated in 57/70 (81.4%) (6– 1200 IU/mL). Total data analysis yielded these results. IL-6 was calculated at 10– 1900 ng/mL, whereas IL-2 was 4– 280. Discharged hospital patients had a statistically significant increase in IgM and IgG (P = 0.01, 0.004) but a statistically insignificant decline in IL-6 and IL-2 (P = 0.761, 0.071). Low IgM levels increased hospital stays. The study found lengthier hospital stays with higher IgG levels.Conclusion: The identification of IgM and IgG antibodies, greater IL-6 levels, and lower IL-2 levels can help diagnose and monitor COVID-19 infection.Keywords: COVID-19 patients, antibodies, cytokines levels, PCR test, ELISA, Saudi Arabia

Background Previous studies have demonstrated residual complement-mediated deposits in repeat kidney biopsies of C3 glomerulopathies (C3G) (dense deposit disease (DDD) and C3 glomerulonephritis) following eculizumab treatment, despite some clinical improvement. With residual complement deposition, it is difficult to determine whether there is a reduced complement-mediated endothelial cell injury. We validated that myeloperoxidase (MPO) immunohistochemical staining identified glomerular endothelial cell injury in crescentic glomerulonephritis and C3G. Case (diagnosis/treatment) We report that MPO staining in the glomerular endothelium of the post-treatment kidney biopsy was significantly reduced after 3 years of eculizumab treatment and clinical improvement in a 5-year-old boy with initial DDD and secondary crescent formation. Conclusion We find that immunostaining for MPO is a useful method to compare glomerular endothelial injury in C3G following eculizumab treatment. This finding also supports the notion that eculizumab, a C5 blocker, may not mainly block C3 deposits in the glomeruli but significantly blocks final activation of the complement cascade, thus reducing glomerular endothelial cell injury., Author(s): Neal B. Blatt [sup.1] , Tripti Kumar [sup.2] , Larysa T. Wickman [sup.1] , Hassan D. Kanaan [sup.3] , Anthony Chang [sup.4] , Ping L. Zhang [sup.3] Author Affiliations: [...]

Ghadir Fakhri Al-Jayyousi, Hanan Abdul Rahim, Diana Alsayed Hassan, Sawsan Mohammed Awada Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, QatarCorrespondence: Ghadir Fakhri Al-JayyousiDepartment of Public Health, College of Health Sciences, QU Health, Qatar University, PO Box 2713, Doha, QatarEmail g.aljayyousi@qu.edu.qaBackground: There is an accelerating need for interprofessional education (IPE) in the Public Health field, as healthcare providers become diverse and multi-disciplinary. Public Health students with health education concentration at Qatar University are required to join training sessions in IPE before the start of their field experience, where students are placed in a variety of community-based and clinical settings including, but not limited to, primary healthcare.Purpose: The goal of this qualitative research study is to understand health education students’ experience in interprofessional care during their field experience in a primary healthcare setting and to highlight the successes and challenges.Patients and Methods: Participants were third-year health education students (N = 22) enrolled in the Public Health program at Qatar University who obtained their experiential learning in three different primary health care centers. Students’ weekly reports reflecting on primary interprofessional care were included in the analysis for the purpose of this study. Following constant comparative techniques, thematic analysis was conducted on health education students’ reports.Results: Interprofessional care was witnessed and practiced by students in teamwork and collaboration for the benefit of the patient, communication among health care professionals and referral process and patient flow. Health education students understood their role in interprofessional care in the fields of behavior change, and patient education and empowerment. However, professionals and patients were not recognizing health educators’ role and were not familiar with their contributions to interprofessional care in primary healthcare. Students suggested delivering interprofessional education for health care providers to enhance collaborative teamwork and promote knowledge about the evolving health education field among healthcare providers in Qatar. In addition, they recommended orienting their training supervisors about the goal of IPE-based practice in a primary healthcare setting.Conclusion: Interprofessional care was observed and practiced by health education students through collaborative teamwork, communication among health care professionals and management of patient flow. However, they faced challenges during their practice-based IPE. The findings can be tailored towards planning for interprofessional education workshops to boost collaboration progress among health care providers including health educators and supporting professionals interested to implement practice-based IPE in their placement curriculums.Keywords: interprofessional collaboration, communication, health education, public health, primary care, field experience

This special issue of the Journal of Consumer Behaviour engages in a scholarly debate on the association between environmental values and sustainable consumption using 16 studies that examine a range of exciting phenomena relevant to the debate. The special issue provides insights into three key areas of scholarly conversations in the field of study. First, it provides recent accounts of the literature on the role of environmental values in sustainable consumption. Given that the association between the two areas has been widely debated for decades, adding novel insights into the phenomenon in the context of recent environmental issues significantly contributes to the field of study. It should be noted that the novel insights cover several mediating and moderating factors of the association, which add new research directions to the field of study. Second, the special issue examines the recent discourse on environmental values considering the more specific behaviours (collaborative consumption, disposal behaviour, consumer engagement in circular economy) that are related to sustainable consumption. This discourse provides insight into environmentally conscious marketing practitioners. Third, the special issue highlights diverse consumer perspectives on sustainable consumption, especially those from diverse consumer generations, both local and international consumers. They inform global initiatives such as the UN sustainable development goals. Overall, engaging in a collective dialogue to understand recent developments in the field of study, the special issue informs environmental policies and fosters sustainable consumption and marketing practices that tackle climate change‐related environmental and social issues. [ABSTRACT FROM AUTHOR]

Study Design: Cross sectional Background: Antenatal means the period of pregnancy from conception to childbirth. Ante natal classes are sessions designed to give a pregnant female and her husband information about pregnancy, delivery and caring for herself and her newborn after birth. These classes can help improve antenatal care. Methods: A cross sectional study done via online forms using convenience sampling. All married adults above age of 15 with at least 1 child born in Saudi Arabia were included in the study. The sample size was 700. Results: 70%of participants said they did not know about antenatal classes and 94% said they had not attended any antenatal classes before. There was no correlation between age at first pregnancy and knowledge about antenatal care however there was significant association (p=.001) between low knowledge of antenatal events and fear and adverse outcome during first pregnancy. 75% of participants said they would attend antenatal classes if it was available. Major sources of knowledge about these events were mothers, friends or internet. Conclusion and Recommendation: Our results show that most of the knowledge women gain about care during antenatal period is not from a medical source but rather from mothers, relatives or internet. So, we would like to recommend to the ministry of health and concerned authorities and stakeholders to plan and implement antenatal classes and health education sessions for women during their routine antenatal visits. [ABSTRACT FROM AUTHOR]

The etiology of minimal change disease (MCD) remains a mystery as the only characteristic findings are the diffuse effacement of foot processes seen on electron microscopy (EM). Punctate IgG staining found floating outside glomerular capillary loops in MCD cases was recently identified as autoimmune antibodies against nephrin of podocytes. We hypothesized that the punctate IgG staining is located on budding ballooning clusters (BBC) of reactive foot processes in Bowman's space found on EM. We identified seven patients with MCD cases showing IgG staining that were subsequently evaluated for BBC on EM. We concurrently examined 12 negative controls, either unremarkable cases or tubulointerstitial diseases, by EM. Immunogold labeling was performed to confirm the presence of IgG and determine localization. In seven MCD cases, there were positive punctate IgG staining particles outside of the glomerular basement membranes (GBM) along with concurrent punctate staining for C3, kappa, and lambda. By EM, all seven (100%) MCD cases revealed BBC that was characterized by ballooning foot processes ranging from 1 to 6 µm and was either budding or detached from the GBM in 3–7 clusters; no electron-dense materials were seen in BBC. BBC was also seen in only 1 of 12 (8%) negative controls. Immunogold labeling identified IgG particles within BBC of MCD by EM, but not in the negative control. Our data suggest that BBC are EM structures of reactive foot processes that are most likely correlated with punctate IgG staining seen in cases of MCD, supported by immunogold labeling for IgG. [ABSTRACT FROM AUTHOR]

Objective: This phase 3, randomized, double‐blind, placebo‐controlled study (NCT02600507) evaluated the efficacy and safety of lumateperone adjunctive therapy to lithium or valproate in patients with bipolar depression. Methods: Patients (18–75 years) with bipolar I or bipolar II disorder experiencing a major depressive episode (MDE), with inadequate therapeutic response to lithium or valproate, were randomized 1:1:1 to 6 weeks adjunctive therapy with lumateperone 28 mg (n = 176), lumateperone 42 mg (n = 177), or placebo (n = 176). The primary and key secondary efficacy endpoints were change from baseline to Day 43 in Montgomery‐Åsberg Depression Rating Scale (MADRS) Total score and the Clinical Global Impression Scale‐Bipolar Version‐Severity Scale (CGI‐BP‐S) depression subscore. Safety assessments included adverse events, laboratory evaluations, vital signs, extrapyramidal symptoms (EPS), and suicidality. Results: Patients treated with adjunctive lumateperone 42 mg showed significantly greater improvement compared with adjunctive placebo in MADRS Total score (LS mean difference vs placebo [LSMD], −2.4; p = 0.02) and CGI‐BP‐S depression subscore (LSMD, −0.3; p = 0.01), while adjunctive lumateperone 28 mg showed numerical improvement in MADRS Total score (LSMD, −1.7; p = 0.10) and improvement in the CGI‐BP‐S depression subscore (LSMD, −0.3; p = 0.04). Adjunctive lumateperone treatment was well tolerated; treatment‐emergent adverse events reported at rates >5% and twice placebo for lumateperone 42 mg were somnolence (11.3%), dizziness (10.7%), and nausea (8.5%), with minimal risk of EPS, metabolic abnormalities, or increased prolactin. Conclusions: Lumateperone 42‐mg treatment adjunctive to lithium or valproate significantly improved depression symptoms and was generally well tolerated in patients with MDEs associated with either bipolar I or bipolar II disorder. [ABSTRACT FROM AUTHOR]