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Hepatitis E virus (HEV) is a small quasi-enveloped ssRNA causing acute hepatitis. HEV is the leading cause of intermittent acute hepatitis and fulminant hepatic failure. Risk factors include drinking contaminated water in developing countries and consumption of infected animal products in developed countries. Previous reports on HEV prevalence in Saudi Arabia had small sample sizes. Nationwide systematic seroprevalence studies are needed to investigate risk factors and annual incidence. Camels play a cultural and economic role in the life of Saudi citizens with frequent human contact and potential role in zoonotic transmission. Future research needs to include larger sample sizes and nationwide studies. Future studies should also focus on raising awareness of HEV infection and the need for wider population testing and screening.

Background The “I COUGH” protocol is associated with improved postoperative pulmonary outcomes, and ambulation is an essential component. I COUGH is an acronym for Incentive spirometry, Coughing, Oral care, Understanding (patient and staff education), Getting-out-of-bed, and Head-of-bed elevation. This trial sought to enhance one component, specifically ambulation after operations. Methods Randomized trial of inpatients in a safety-net, academic medical center. The intervention group received standard I COUGH education along with text message reminders to ambulate postoperatively, whereas the control group received standard education alone. Postoperative walking frequency was compared to each participant’s ambulation on the day prior to enrollment. Results The intervention group had an average improvement of 1.8 ± 1.8 walks per day per patient, while the average change for the control group was 0.2 ± 1.0 walks per day per patient. This represents a 9-fold increase in ambulation for the intervention group (p = 0.03). Conclusions Implementation of text message reminders increased ambulation and improved adherence to the I COUGH protocol following operations. This system should be further investigated as an adjunct to postoperative care.

AIM: The aim of the study is to assess the failure rate after mini-screw insertion using digital three-dimensional printed guide versus free hand placement technique through a well-designed split-mouth randomized clinical trial. METHODS: Forty-two patients with mean age (22.56 ± 3.47 years) indicated for upper first premolars’ extraction (Bimaxillary protrusion and Class II division 1) were included in the study. Their maxillary quadrants were randomized to receive mini-screws as means of anchorage. Pre-operative maxillary cone-beam computed tomography scan with ultra-low-dose protocol was imaged and the maxillary arch was scanned using intra-oral scanner to obtain stereo-lithographic format file for the maxillary arch. Using in vivo and Rapidform Geomagic Studio® _Softwares the mini-screws were planned to be inserted in the buccal inter-radicular space between the upper second premolar and first molar in both right and left sides. For the intervention sides; digital three-dimensional guides were designed and printed for mini-screw insertion. Failure of the mini-screws was assessed till 3 months of loading. RESULTS: There was no statistical significant difference in failure rate of mini-screws in both intervention (7.14%) and control sides (16.6%), with weak and moderate correlation between the root proximity and the mini-screws failure in intervention and control groups respectively. CONCLUSIONS: Using a digital three-dimensional printed guide for mini-screw insertion had no effect on the failure rate of the inserted mini-screws. REGISTRATION: ClinicalTrials.gov Identifier: NCT03653078.

As fellowship training after general surgery residency has become increasingly common, the impact on resident education must be considered. Patient safety and procedure outcomes are often used as justification by attendings who favor fellows over residents in certain minimally invasive surgery (MIS) operations. The aim of the present study was to compare the impact of trainee level on the outcomes of selected MIS operations to determine if giving preference to fellows on grounds of outcomes is warranted. Patients who underwent elective laparoscopic hiatal hernia repair (LHHR), laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic splenectomy (LS), laparoscopic cholecystectomy (LC), or laparoscopic ventral hernia repair (LVHR) with assistance of a general surgery chief resident or fellow were identified from the American College of Surgeon’s National Surgical Quality Improvement Program database (2007–2012). Patients were matched 1:1 based on propensity score for the odds of undergoing operations assisted by a fellow. 5145 patients underwent LHHR, 1396 LSG, 9656 LRYGB, 863 LS, 13,434 LC, and 3069 LVHR. Fellows assisted in 41.7% of LHHR, 49.2% of LSG, 56.4% of LRYGB, 25.7% of LS, 17.1% of LC, and 27.0% of LVHR cases. After matching, overall and severe complication rates were comparable between cases performed with assistance of a fellow or chief resident. Median operative time was longer for LSG, LRYGB, and LC when a fellow assisted. Surgical outcomes were similar between fellow and chief resident assistance in MIS operations, arguing that increased resident participation in basic and complex laparoscopic operations is appropriate without compromising patient safety.

The COVID-19 was identified for the first time from the sea food market, Wuhan city, China in 2019 and the pathogenic organism was identified as SARS-CoV-2. Currently, this virus has spread to 223 countries and territories and known as a serious issue for the global human community. Many vaccines have been developed and used for immunization.We have reported the insilico prediction, designing, secondary structure prediction, molecular docking analysis, andThe analyzed data resulted in the selection of only three siRNAs out of twenty-six siRNAs generated by online software. The secondary structure prediction and molecular docking analysis of siRNAs revealed the efficient binding to the target. There was no cellular toxicity observed in the HEK-293 cells at any tested concentrations of siRNAs. The purification of RNA was completed from inoculated cells and subjected to q-RT-PCR. The highest Ct value was observed in siRNA 3 than the others. The results offered valuable evidence and invigorated us to assess the potency of siRNAs by using alone or in combination in other human cells.The data generated from this study indicates the significance of in silico prediction and narrow down the potential siRNA' against SARS-CoV-2, and molecular docking investigation offered the effective siRNAs binding with the target. Finally, it is concluded that the online bioinformatics approach provided the prediction and selection of siRNAs with better antiviral efficacy. The siRNA-3 was observed to be the best for reduction of viral RNA in cells.

Well integrity is one of the main challenges that are facing operators, finding the source of the well problem and isolating it before a catastrophic event occurs. This study demonstrates the power of integrating different reservoir monitoring and well integrity logs to evaluate well integrity, identify the underlying cause of the potential failure, and providing a potential corrective solution. Recently, some Injector/producer wells reported migration of injection fluids/gas into shallower sections, charging these formations and increasing the risk of compromised well integrity. Characterization of the well issues required integration of multi-detector pulsed-neutron, well integrity (multi finger caliper, multi-barrier corrosion, cement evaluation, and casing thickness measurements), high precision temperature logs and spectral noise logs. After data integration, detailed analysis was performed to specifically find the unique issues in each well and assess possible corrective actions. The integrated well integrity logs clearly showed different 9.625-inch and 13.375-inch casings leak points. The reservoir monitoring logs showed lateral and vertical gas and water movements across Wara, Tayarat, Rus, and Radhuma formations. Cement evaluation loges showed no primary cement behind the first barrier casing which was the root cause of the problem. Therefore, the proposed solution, was a cement squeeze. Post squeeze, re-logging occurred, validating zonal isolation and a return of a standard geothermal gradient across the Tayarat formation. Most importantly, the cement evaluation identified good bond from the squeeze point clear to surface, isolating all formations. All these wells were returned to service (injector/producer), daily annular pressure monitoring confirmed that no further pressure build up was seen. Kuwait Oil Company managed to avoid a catastrophic well integrity event on these wells and utilized the approach presented to take the proper corrective actions, and validate that the action taken resolved the initial well integrity issues. Consequently, the wells were returned to service, and the company avoided a costly high probability blowout.

Background Ventral hernia repair is common in the expanding aging population, but remains challenging due to their frequent comorbidities. The purpose of this study is to compare the surgical outcomes of open vs. laparoscopic ventral hernia repair in elderly patients. Methods Patients ≥ 65 years of age that underwent elective open or laparoscopic ventral hernia repair were identified from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database. To reduce potential selection bias, propensity scores were created for the likelihood of undergoing laparoscopic surgery based on patients' demographics and comorbidities. Patients were matched based on the logit of the propensity scores. Thirty-day surgical outcomes were compared after matching using Chi-square test for categorical variables and the Wilcoxon Rank-Sum test for continuous variables. Results 35,079 (71.1%) and 14,270 (28.9%) patients underwent open and laparoscopic ventral hernia repairs, respectively. Laparoscopic surgery was associated with a lower overall morbidity (5.9% vs. 9.1%; p Conclusion Although open surgery remains the most prevalent in the elderly population, the results of this study suggest that laparoscopic surgery is safe and associated with a lower risk of overall morbidity, surgical site infections, and reoperation.

Objectives: This study aimed to enhance Osseo densification by using Platelet-rich fibrin (PRF) on sinus lifting of maxillary implant in class II partially edentulous cases. Materials and Methods: fourteen maxillary class II partially edentulous patients were selected and divided into two groups. Single implant was inserted in the edentulous region with closed sinus lifting technique for each patient in both groups, for group I implant was placed with the Densah bur drilling system together with PRF while in group II other implant was placed with that same system without PRF. Implant primary stability was measured using Resonance Frequency Analysis by Osstell immediately after torqueing the implants and every two weeks for 2 months. Rate of bone formation was followed up by taking CBCT after implant loading and followed up for one year. Results: No significant difference was found regarding Osstell values at all follow up appointments for both groups. Regarding the bone formation, the group with PRF there was significant difference than the group without PRF. Conclusions: Using Densah burs in closed sinus lifting consider very safely and effective technique and using PRF as grafting material in closed sinus lifting enhancing rate of bone formation.

The acute cases of pneumonia (COVID-19) were first reported from China in December 2019, and the pathogen was identified as SARS-CoV-2. Currently, many vaccines have been developed against this virus by using multiple genes, applying different platforms, and used for the vaccinations of the human population. Spike protein genes play an important role in host cell attachment and viral entry and have been extensively used for the development of vaccine and antiviral therapeutics. Short interfering RNA is also known as silencing RNA and contribute a significant role to regulate the expression of a specific gene. By using this technology, virus inhibition has been demonstrated against many viral diseases.In this work, we have reported the Insilico prediction, designing, and experimental validation of siRNAs antiviral potency against SARS-CoV-2-S-RBD. The siDirect 2.0 was selected for siRNAs prediction, and secondary structure was predicted by RNAfold while the HNADOCK was used for molecular docking analysis and specific binding of siRNAs to the selected target. We have used and evaluated four siRNAs for cellular toxicity and determination of antiviral efficiency based on the Ct value of q-real-time PCR in Vero E6 cells.Based on the experimental evaluation and analysis of results from generated data, we observed that there is no cytotoxicity for any tested siRNAs in Vero E6 cells. Total four siRNA were filtered out from twenty-one siRNAs following the strict selection and scoring criteria. The better antiviral efficiency was observed in 3rd siRNAs based on the Ct value of q-real-time PCR. The results that emerged from this study encouraged us to validate the efficiency of these siRNAs in multiple cells by using alone and in a combination of two or more siRNAs to inhibit the SARS-CoV-2 proliferation.The Insilico prediction, molecular docking analysis provided the selection of better siRNAs. Based on the experimental evaluation only 3rd siRNA was found to be more effective than others and showed better antiviral efficiency. These siRNAs should also be evaluated in other cell lines either separately or in combination against SARS-CoV-2 to determine their antiviral efficiency.

Several studies demonstrated language that discordant care between may lead to mixed outcomes and increased use of hospital-resources. In the setting of bariatric surgery, which relies heavily on intensive pre-operative and post-operative counseling, we hypothesized that patients with LEP would have less favorable outcomes compared to English-proficient (EP) patients.All patients 18 years and older, who underwent laparoscopic sleeve gastrectomy (SG) or laparoscopic gastric bypass (LGBP) from January 2013 to December 2017 were included. Language proficiency was determined by chart review for the use of an interpreter at least once during the study period. Outcomes of interest at 30-days and 1 year included: emergency department (ED) visits, readmission, length of stay (LOS), chief-complaint on readmission, and post-operative complications. Additionally, comorbidity remission and weight loss at one year was recorded.A total of 671 patients were categorized as LEP (40%) and spoke 6 unique languages. Within the 1 year post-operative period, EP patients presented to the ED more than LEP patients (23% vs. 14% p lt; 0.001). After multivariable regression for potential confounders this difference persisted; adjusted OR = 0.65 (95% CI 0.43-0.95; p = 0.029). However, despite more frequent ED visits by EP patients, there was no significant difference in readmission within one year; adjusted OR = 0.94 (95% CI 0.56-1.55; p = 0.50). Both groups demonstrated similar successful weight loss at 1 year: EP-31.85% (LGBP) and - 28.02% (SG) vs. LEP-30.17% (LGBP) and - 28.36% (SG). EP and LEP patients also had similar remission of obesity-related comorbidities.There were no differences in outcomes following bariatric surgery when comparing patients with limited English proficiency to those who are proficient in English. Bariatric surgical care can be delivered in a safe and effective manner with equivalent outcomes between patients who are and are not English-language proficient.

The Caprini risk assessment model is a well-validated tool that identifies patients who would benefit from extended venous thromboembolism (VTE) prophylaxis beyond hospital discharge. VTE, particularly portal mesenteric vein thrombosis (PMVT), is a potentially devastating complication of laparoscopic sleeve gastrectomy (LSG); therefore, we sought to examine whether the model can be safely applied to LSG patients. We hypothesized that its use can minimize the incidence of postoperative VTE, including PMVT, without increasing the likelihood of bleeding complications.We conducted a retrospective chart review of those patients who underwent LSG at our institution from 2010 and 2018, at which time the Caprini risk assessment model was already our institutional standard. We determined the patients' Caprini scores at the time of discharge and whether patients at high risk of VTE were discharged from hospital on extended courses of VTE prophylaxis. We also recorded if bleeding complications or VTE events occurred in the first 180 days after LSG.Six hundred thirty-eight patients underwent LSG, including 521 (81.7%) women, with an average preoperative body mass index (BMI) of 44.4 kg/mThe Caprini risk assessment model can effectively identify patients after LSG who might benefit from extended courses of VTE prophylaxis. Extended VTE prophylaxis does not seem to confer increased bleeding risk in this patient population.

Japanese encephalitis (JE) virus is a flavivirus causing encephalitis causing neurological damage. RNA-dependent-RNA-polymerase (RdRp) is responsible for genome replication making it excellent anti-viral target. In this study, the crystal structure of JE RdRp (jRdRp) and bioflavonoids reported in Azadirachta indica were retrieved from specific databases. Structure-based virtual screening was employed using MTiOpenScreen server and top four compounds selected with the most negative docking scores. Conformations were redocked using AutoDock Vina; these complexes showed mechanistic interactions with Arg474, Gly605, Asp668, and Trp800 residues in the active site of jRdRp, i.e., guanosine-5′-triphosphate. Furthermore, 100 ns classical molecular dynamics simulation and binding free energy calculation showed stability of docked bioflavonoids in the active jRdRp pocket and significant contribution of van-der-Waals interactions for docked complex stability during simulation. Therefore, this study predicted the anti-viral activity of Gedunin, Nimbolide, Ohchinin acetate, and Kulactone against jRdRp and can be considered for further antiviral drug development.

Japanese encephalitis (JE) virus, belongs to the genus flavivirus, is a major cause of viral encephalitis, which results in neurological damage. RNA-dependent RNA polymerase (RdRp) protein is the sole enzyme responsible for viral genome replication in RNA viruses and serves as an excellent target for anti-viral therapeutic development, as its homolog is not present in humans. In this study, the crystal structure of JE RNA-dependent RNA polymerase (jRdRp) protein was obtained from protein data bank while 43 by bioflavonoids reported in Azadirachta indica were retrieved from the PubChem database. Following, structure based virtual screening was employed using MTiOpenScreen server and top four compounds, viz. Gedunin, Nimbolide, Ohchinin acetate, and Kulactone, with the most negative docking scores (> -10 kcal/mol) conformations were redocked using AutoDock Vina; these complexes showed mechanistic interactions with Arg474, Gly605, Asp668, and Trp800 residues in the active site of jRdRp protein against reference ligand, i.e., Guanosine-5’-Triphosphate. Furthermore, 100 ns classical molecular dynamics simulation and binding free energy calculation showed considerable stability (via hydrogen bonding and hydrophobic interactions) of docked bioflavonoids in the active pocket of jRdRp and significant contribution of van der Waals interactions for docked complex stability during simulation, respectively. Therefore, the outcome of this study predicted the substantial anti-viral activity of Gedunin, Nimbolide, Ohchinin acetate, and Kulactone against jRdRp protein and can be considered for further antiviral drug development.

BACKGROUND: Patient’s satisfaction and the preservation of abutments is the most important outcomes that the clinician seeks during fabrication of any dental treatment, especially when it is concerned with removable prosthodontic rehabilitation. AIM: The present study evaluates three different Removable Partial Denture (RPD) types restoring mandibular class II modification I edentulous cases with regards to patient’s satisfaction and abutments survival. METHODS: Forty-two partially edentulous patients were divided into three groups (Group I rehabilitated with Vitallium RPD, Group II rehabilitated with Vitallium RPD where the modification area restored with the surveyed bridge, Group III rehabilitated with Thermopress RPD). The patients were followed up for twenty-four months. Using a questionnaire, prosthodontic maintenance required was documented at the delivery and after 3 months. RESULTS: There was a significant difference regarding patient satisfaction for group III (P-value 0.05). Regarding the survival rate, there was a non-significant difference between the three groups (P-value >0.05) at the end of twenty-four months of follow up. CONCLUSION: Patient satisfaction and abutment survival were better with Thermopress RPD than conventional Vitallium RPD or Vitallium RPD with a surveyed bridge restoring the modification area. Although a non-statistically significant difference was found in the survival rate of abutments between groups, a clinically important result was revealed as no abutments failures were reported in the Thermopress group.

BACKGROUND: Utilization of attachments in a removable partial denture is highly essential not only as a line of treatment but also as it has a remarkable impact on the denture’s durability during the function. The attachment should act as a stress breaking system preserving the abutment teeth. AIM: This consideration aimed to verify the convention of polyether ether ketone (PEEK) material as an attachment. MATERIAL AND METHODS: Four groups of different materials for both attachments and partial denture framework were fabricated and tested using strain gauges to compare between them according to the strains originated around both the abutment teeth and edentulous area. RESULTS: PEEK material is one of the esthetic materials used for fabrication of the framework of the RPD. On using it as a precision attachement is shows favorable stress distribution decreasing the strains around the abutment teeth and the alveolar ridge especially distal to the abutment teeth that was significantly reduced in comparison with the other treatment options. CONCLUSION: Utilization of PEEK material as both an attachment and framework decline the strains performed around the abutment teeth and over the edentulous ridge.

BACKGROUND: Retainers are of great importance for the longevity of the prosthetic removable partial denture during various functions especially the esthetic one. The key of successful clasp selection is to select a direct retainer that will control tipping and torquing forces on the abutment teeth, provide retention against reasonable dislodging forces and are compatible with both tooth and tissue contour together with the aesthetic desire of the patient. AIM: This study aims to compare different clasp material to enhance the choice of the clasp based on the aesthetic point of view. METHODS: The colour evaluation of the tested materials had been evaluated by computer aided technique with digital camera with 3 Mega Pixels of resolution. RESULTS: In the current research, the technique of colour evaluation was carried out to compare different clasp materials to enhance the choice of the clasp based on the aesthetic point of view. Most commonly, Removable Partial Denture (RPD) retainers are fabricated identically from the metal framework’s alloy as Cobalt Chromium (CoCr) alloy although it is unaesthetic. This esthetic problem has been overcome by other methods and by utilising different materials, these included covering the retainers with tooth-coloured acrylic resin, as well as the introduction of esthetic materials as; Thermoplastic Acetal, Versacryl, and Thermopress. CONCLUSION: It has been concluded that the non-metallic Acetal resin clasp shows superior physical properties regarding colour stability.

As fellowship training after general surgery residency has become increasingly common, the impact on resident education must be considered. Patient safety and procedure outcomes are often used as justification by attendings who favor fellows over residents in certain minimally invasive surgery (MIS) operations. The aim of the present study was to compare the impact of trainee level on the outcomes of selected MIS operations to determine if giving preference to fellows on grounds of outcomes is warranted.Patients who underwent elective laparoscopic hiatal hernia repair (LHHR), laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic splenectomy (LS), laparoscopic cholecystectomy (LC), or laparoscopic ventral hernia repair (LVHR) with assistance of a general surgery chief resident or fellow were identified from the American College of Surgeon's National Surgical Quality Improvement Program database (2007-2012). Patients were matched 1:1 based on propensity score for the odds of undergoing operations assisted by a fellow.5145 patients underwent LHHR, 1396 LSG, 9656 LRYGB, 863 LS, 13,434 LC, and 3069 LVHR. Fellows assisted in 41.7% of LHHR, 49.2% of LSG, 56.4% of LRYGB, 25.7% of LS, 17.1% of LC, and 27.0% of LVHR cases. After matching, overall and severe complication rates were comparable between cases performed with assistance of a fellow or chief resident. Median operative time was longer for LSG, LRYGB, and LC when a fellow assisted.Surgical outcomes were similar between fellow and chief resident assistance in MIS operations, arguing that increased resident participation in basic and complex laparoscopic operations is appropriate without compromising patient safety.

Background The COVID-19 pandemic has claimed many lives and strained the US health care system. At Boston Medical Center (BMC), a regional safety net hospital, the Department of Surgery created a dedicated, COVID-19 Procedure Team to ease the burden on other providers coping with the surge of infected patients. As restrictions on social distancing are lifted, health systems are bracing for additional surges in COVID-19 cases. Our objective is to quantify the volume and types of procedures performed, review outcomes, and highlight lessons for other institutions that may need to establish similar teams. Study Design Procedures were tracked prospectively along with patient demographics, immediate complications, and time from donning to doffing of the personal protective equipment (PPE). Retrospective chart review was conducted to obtain patient outcomes and delayed adverse events. We hypothesized that a dedicated, surgeon-led team would perform invasive bedside procedures expeditiously and with few complications. Results From March 30 to April 30, 2020, there were 1,196 COVID-19 admissions. The Procedure Team performed 272 procedures on 125 patients, including placement of 135 arterial catheters, 107 central venous catheters, 25 hemodialysis catheters, and 4 thoracostomy tubes. Specific to central venous access, the average procedural time was 47 minutes, and the rate of immediate complications was 1.5%, including 1 arterial cannulation and 1 pneumothorax. Conclusions Procedural complication rate was less than rates reported in the literature. The team saved approximately 192 hours of work that could be re-directed to other patient care needs. In times of crisis, redeployment of surgeons (who arguably have the most procedural experience) into procedural teams is a practical approach to optimize outcomes and preserve resources., Highlights TOC Statement- 20200796 Formation of a surgeon-run, COVID-19 Procedure Team eased the workload of providing medical care to COVID-19 patients, decreased exposures to COVID-19, conserved personal protective equipment, and allowed for expeditious bedside procedures at lesser-than-expected rates of complications. The importance of this study is that it may serve as a guide for surgeons in future acute disruptions to the health care system and provides data on realistic anticipated outcomes.