Inappropriate laboratory test utilization in outpatient tertiary care: Implications for value-based healthcare

OBJECTIVES

To assess the rate of inappropriate repetition of laboratory testing and estimate the cost of such testing for thyroid stimulating hormone (TSH), total cholesterol, vitamin D, and vitamin B12 tests.

METHODS

A retrospective cohort study was carried out in the Family Medicine and Polyclinic Department at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Clinical and laboratory data were collected between 2018-2021 for the 4 laboratory tests. The inappropriate repetition of tests was defined according to international guidelines and the costs were calculated using the hospital prices.

RESULTS

A total of 109,929 laboratory tests carried out on 23,280 patients were included in this study. The percentage of inappropriate tests, as per the study criteria, was estimated to be 6.1% of all repeated tests. Additionally, the estimated total cost wasted amounted to 2,364,410 Saudi Riyals. Age exhibited a weak positive correlation with the total number of inappropriate tests (r=0.196, p=0.001). Furthermore, significant differences were observed in the medians of the total number of inappropriate tests among genders and nationalities (p<0.001).

CONCLUSION

The study identified significantly high rates of inadequate repetitions of frequently requested laboratory tests. Urgent action is therefore crucial to overcoming such an issue.

Effect of nano bentonite on direct yellow 50 dye removal; Adsorption isotherm, kinetic analysis, and thermodynamic behavior

Developing countries suffering from the toxicity of different industrial effluents especially dyes. This study successfully prepared and characterized nano-bentonite for anionic dye removal (DY 50). The prepared nanoparticles were characterized by X-Ray Diffraction (XRD), X-ray Fluorescence (XRF), Scanning Electron Microscope (SEM), EDAX analysis, FT-IR, and TGA and the obtained results indicated the formation of nanoparticles with an average size of 15 nm. The effect of different operating conditions was studied using different pH, dose, contact time, temperature, and initial DY 50 concentrations. The obtained results indicated that nano bentonite was able to adsorb about 78.3 and 100% for initial concentrations of 100±8.1 and 20 ±1.62 mg/L, respectively. The optimum removal conditions were observed at acidic media (pH 3) using sorbent material dosage 1 g/L for 45 min and 30°C. The adsorption isotherm, kinetic analysis, and thermodynamic behavior were studied by using linear equation form, and the adjusted R2 was compared to detect the preferred models. The adsorption isotherm indicated that heterogeneous, as well as multilayer adsorption, plays an important role in the removal of dye. Kinetic studies indicated the chemisorption interaction between sorbed and adsorbed molecules. Thermodynamic behavior indicated the reaction is exothermic with ∆H equal to −5.24 KJ/mol and ∆S equal −74.2 J/K.mol. Finally, this study strongly recommended using nano bentonite for DY 50 removal from an aqueous solution. The RSM relations show significant relations in all removal models with p-value <0.001. The ANN results indicated that the most effective operating conditions are the effect of nano bentonite dose followed by the pH effect.

Comparative Studies of Using Nano Zerovalent Iron, Activated Carbon, and Green Synthesized Nano Zerovalent Iron for Textile Wastewater Color Removal Using Artificial Intelligence, Regression Analysis, Adsorption Isotherm, and Kinetic Studies

Daily, a big extent of colored, partially treated textile effluents drained into the sanitation systems causing serious environmental concerns. Therefore, the decolorization treatment process of wastewater is crucial to improve effluent quality. In the present study, 3 different sorbent materials, nano zerovalent iron (nZVI), activated carbon (AC), and green-synthesized nano zerovalent iron (GT-nZVI), have been prepared for raw textile wastewater decolourization. The prepared nanomaterials were characterized via X-ray diffraction (XRD) spectroscopy, scanning electron microscopy (SEM), energy dispersive X-ray (EDX) analysis, and UV-Vis absorption spectroscopy. In addition, the effect of different operating parameters such as pH, contact time, and stirring rate on the color removal efficiency was extensively studied to identify the optimum removal conditions. The reaction temperature, adsorbent dose, and initial color concentration were fixed during the experiments at room temperature, 0.7 g/L, and 350 and 50 mg/L Pt/Co color unit, respectively. Moreover, adsorption and reaction kinetics were analyzed using different isotherms and models. For simulating the adsorption process, artificial neural network (ANN) data were compatible with the result of regression analysis derived from response surface methodology (RSM) optimization. Our results showed the higher ability of nZVI, AC, and GT-nZVI in textile wastewater color removal. At pH 5, contact time 50 minutes, and stirring rate 150 rpm, nZVI showed good color removal efficiency of about 71% and 99% for initial color concentrations of 350 and 50 mg/L Pt/Co color unit, respectively. While slightly higher color removal ability of about 72% and 100% was achieved by using AC at pH 8, contact time 70 minutes, and stirring rate 250 rpm. Finally, the largest ability of color removal about 85% and 100% was recorded for GT-nZVI at pH 7, contact time 40 minutes, and stirring rate 150 rpm. This work shows the enhanced color removal ability of GT-nZVI as a potential textile wastewater decolourization material, opening the way for many industrial and environmental applications.

A novel Bluetongue virus serotype 3 strain in Tunisia, November 2016

Since 1998, southern Europe has experienced multiple incursions of different serotypes and topotypes of Bluetongue virus, a vector-borne transmitted virus, the causative agent of Bluetongue (BT), a major disease of ruminants. Some of these incursions originated from northern Africa, likely because of wind-blown dissemination of infected midges. In this report, we describe the detection and whole genome characterization of a novel BTV-3 strain identified in a symptomatic sheep in Tunisia. Sequences were immediately deposited with the GenBank Database under Accession Nos KY432369-KY432378. Alert and preparedness are requested to face the next vector seasons in northern Africa and the potential incursion of this novel strain in southern Europe.

Corchorus Olitorius Linn: A Rich Source of Ω3-Fatty Acids

Fatty acids composition of Corchorus olitorius Linn were identified as their methyl esters using accurate mass gas chromatography quadrupole time of flight mass spectrometry (GCQTOF) in chemical ionization (CI) and electron ionization (EI) modes. The leaves which are the edible part of the plant were found to be very rich in ω3-octadecatriene fatty acid reaching up to more than 49 % of the total fatty acids contents. This is the first report to unequivocally detect ω-3 fatty acid in Corchorus olitorius Linn with a much higher concentration than any other reported vegetable and further investigation into its health effects are clearly warranted.

Removal of intra-abdominal mislocated intrauterine devices by laparoscopy

This retrospective study was carried out on 15 patients who underwent laparoscopy for the removal of a mislocated IUD from 2003 to 2009. The mean duration of usage of an IUD was 16.1 months. The IUD was found in the Pouch of Douglas in six patients; in the posterior wall of the uterus in three patients; in the adnexa in three patients; in the omentum in two patients and it was embedded in the rectal serosa in one patient. The types of the IUDs were TCu-380A (n = 13) and Mirena(®) (n = 2). The mean laparoscopic operation time was 25 min. No major complications occurred. A second ancillary port was required in three patients. All patients were discharged within 24 h. Laparoscopic removal of the intra-abdominal IUD must be the first choice of therapy. If possible, a single ancillary port should be preferred for the removal of mislocated IUDs. We advise that surgical removal and surgical risk should be discussed with the patients, even if asymptomatic.

Bilateral uterine and ovarian artery ligation in addition to B-lynch suture may be an alternative to hysterectomy for uterine atonic hemorrhage

PURPOSE OF INVESTIGATION

To evaluate the effectiveness of bilateral uterine arteries and ovarian artery ligation followed by B-Lynch compression suturing in controlling atonic postpartum hemorrhage.

METHODS

In this retrospective study, the data of eight patients that had uterine atony during cesarean section and treated by bilateral uterine and ovarian artery ligation followed by B-Lynch compression suturing during the period from February 2009 to September 2010 were collected and analyzed.

RESULTS

Eight cases were treated by the above protocol; the average age of the patients was 25.25 +/- 5.09 years, and the mean gestational age was 35.75 +/- 3.80 weeks. Seven of the patients were primiparous. They were hospitalized on average 5.25 +/- 2.31 days. The mean operation time was 61.25 +/- 24.60 minutes and mean estimated blood loss was 2787.5 +/- 1573.38 ml. Internal iliac artery ligation was necessary in one patient only. Hysterectomy was not performed in any of the patients. Five patients had intraoperative or postoperative blood transfusion.

CONCLUSION

The addition of uterine artery and ovarian artery ligation to the B-Lynch suture may be considered as a major hemostatic step before proceeding to hysterectomy in cases of uterine atony bleeding, and all gynecologic surgeons should be familiar with it.

The effect of propolis on dentinal hypersensitivity and level of satisfaction among patients from a university hospital Riyadh, Saudi Arabia

Propolis has been used since ancient times in folk medicine for its beneficial effects. It is a mixture of resin, essential oils and waxes mixed with bee glue; also it contains amino acid, minerals, ethanol, vitamin A, B Complex, E, Pollen and highly active ingredient known as Bioflavenoid (Simon Martin 1991). To date, there have been no studies done on desensitizing effect of Propolis in vivo. So, the aims of this study are to evaluate the effect of Propolis in a clinical trial on subjects with dentinal hypersensitivity, and to assess the level of satisfaction among subjects after they have used the Propolis. Twenty six Saudi female subjects at King Saud University, College of Dentistry, Riyadh, Saudi Arabia, age ranged from 16-40 yr. (mean = 23 yrs.), were included in the study over a period of four weeks. The Cervical Dentinal Sensitivity (C.D.S.) was assessed by two methods: 1--cold air stimuli. 2--Subjective reporting of pain, with a modified questionnaire (Gillam 1997) and a numerical scale 0-10 (Downie et al 1978). The patients were followed up for four weeks after using Propolis, there were two recalls, and the first recall was after one week and the second recall after four weeks of the base line. The results between the base line findings and after four weeks were statistically significant. Eighty five percent of the subjects were found highly satisfied; the Propolis had significant effect on dentinal hypersensitivity during the study period. Further research is needed with double blind clinical trial on a large sample size.