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This is a case–control study of our experience of mid-term follow-up of 40 children who had a transcatheter closure of very large atrial septal defects group (1). All cases had an atrial septal defect device size more than 1.5 times their weight, a ratio considered a contraindication for trans catheter closure (TCC) in some previous reports. The aim of this study is to report the outcomes and mid-term follow-up of transcatheter closure of large atrial septal defects using two-dimensional conventional echocardiography, tissue Doppler imaging, and four-dimensional speckle tracking imaging, and as such to compare results of same echocardiographic examination of age-matched control group of 40 healthy children group (2). Cardiac MRI was performed on cases group (1) only to detect right ventricle and left ventricle volumes and function and early signs of complications. There was no difference between cases and matched healthy controls in terms of the assessment of left ventricle and right ventricle by two-dimensional echocardiography, tissue Doppler imaging, and four-dimensional speckle tracking imaging. Similarly, there was no statistically significant difference between four-dimensional echocardiography and cardiac MRI in their respective assessment of both left ventricle and right ventricle volumes and function. We also detected no complications by echo or by cardiac MRI after a median follow-up period of 2 years and recorded a complete remodelling of right ventricle volumes in all children studied. This points to the safety and efficiency of transcatheter closure of large atrial septal defects in children on mid-term follow-up.
The transition of foods during toddlerhood and the suboptimal diets consumed in the Middle East make children susceptible to malnutrition and micronutrient deficiencies. Based on international recommendations, coupled with the merits of clinical studies on the application of young child formula (YCF), a group of fourteen experts from the Middle East reached a consensus on improving the nutritional status of toddlers. The recommendations put forth by the expert panel comprised twelve statements related to the relevance of YCF in young children; the impact of YCF on their nutritional parameters and functional outcomes; characteristics of the currently available YCF and its ideal composition; strategies to supply adequate nutrition in young children and educational needs of parents and healthcare professionals (HCPs). This consensus aims to serve as a guide to HCPs and parents, focusing on improving the nutritional balance in toddlers in the Middle Eastern region. The panellists considere YCF to be one of the potential solutions to improve the nutritional status of young children in the region. Other strategies to improve the nutritional status of young children include fortified cow's milk and cereals, vitamin and mineral supplements, early introduction of meat and fish, and the inclusion of diverse foods in children's diets.
We present a discussion of the structure of line fires, a canonical configuration in wildland fire research. This configuration allows detailed studies of the effects of wind and sloped terrain on heat transfer and fire spread mechanisms at flame scale. We emphasize in the discussion the existence of two limiting flame regimes in line fires: the plume-dominated regime, in which the flame is detached from the ground, and the wind or slope-driven regime, in which the flame is attached to that surface. These two regimes correspond to dramatically different flame structures, flow patterns, modes of heat transfer, and flame spread mechanisms. The transition between the two flame regimes is discussed in terms of critical values of Byram's convection number or slope angle. We limit our discussion to a simplified configuration corresponding to gas-fueled flames. Hence the heat release rate of the flame is controlled and the flame is non-spreading; difficulties associated with real wildland fuel are left out of the discussion. The structure of the line fires is discussed through results from high-resolution simulations of laboratory-scale flames based on a large eddy simulation (LES) approach. Additional insight is also obtained through a scaling analysis based on an integral model.
Antimicrobial resistance (AMR) is a global priority with significant clinical and economic consequences. Multidrug-resistant (MDR) Pseudomonas aeruginosa is one of the major pathogens associated with significant morbidity and mortality. In healthcare settings, the evaluation of prevalence, microbiological characteristics, as well as mechanisms of resistance is of paramount importance to overcome associated challenges.
Consecutive clinical specimens of P. aeruginosa were collected prospectively from 5 acute-care and specialized hospitals between October 2014 and September 2017, including microbiological, clinical characteristics and outcomes. Identification and antimicrobial susceptibility test were performed using the BD Phoenix identification and susceptibility testing system, matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI-TOF MS), and minimum inhibitory concentration (MIC) test strips. Overall, 78 selected MDR P. aeruginosa isolates were processed for whole-genome sequencing (WGS).
The overall prevalence of MDR P. aeruginosa isolates was 5.9% (525 of 8,892) and showed a decreasing trend; 95% of cases were hospital acquired and 44.8% were from respiratory samples. MDR P. aeruginosa demonstrated >86% resistance to cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam but 97.5% susceptibility to colistin. WGS revealed 29 different sequence types: 20.5% ST235, 10.3% ST357, 7.7% ST389, and 7.7% ST1284. ST233 was associated with bloodstream infections and increased 30-day mortality. All ST389 isolates were obtained from patients with cystic fibrosis. Encoded exotoxin genes were detected in 96.2% of isolates.
MDR P. aeruginosa isolated from clinical specimens from Qatar has significant resistance to most agents, with a decreasing trend that should be explored further. Genomic analysis revealed the dominance of 5 main clonal clusters associated with mortality and bloodstream infections. Microbiological and genomic monitoring of MDR P. aeruginosa has enhanced our understanding of AMR in Qatar.
How does exposure to conspiracy theories affects voters’ political attitudes? Using an online experiment among US subjects, we show that exposure to conspiracy theories decreases voters’ trust in the domestic informational environment. Subjects were exposed to conspiracy theories that are entirely unrelated to American domestic politics, which further underscores such narratives’ danger. However, we fail to reject the null hypothesis that voters do not weigh unrelated conspiracies in their evaluation of politicians’ performance and domestic political institutions. Overall, our findings illustrate that an informational environment permeated by conspiracy theories could impede the functioning of democracy by eroding trust in information providers and undermining the credibility of political information.
Epilepsy is a prevalent and chronic neurological disorder marked by recurring, uncontrollable seizures of the brain. Chronic or repeated seizures produce memory problems and induce damage to different brain regions. Histamine has been reported to have neuroprotective effects. Betahistine is a histamine analogue. The current research investigated the effects of convulsions on the cerebral cortex and hippocampus of adult male albino mice and assessed the possible protective effect of betahistine. Four groups of 40 adult male mice were organized: control, betahistine (10 mg/kg/day), pentylenetetrazole (PTZ) (40 mg/kg/ on alternate days), and Betahistine-PTZ group received betahistine 1 h before PTZ. PTZ induced a substantial rise in glutamate level and a considerable decrease in histamine level. Structural changes in the cerebral cortex and cornu ammonis (CA1) of the hippocampus were detected in the pattern of neuron degeneration. Some neurons were shrunken with dark nuclei, and others had faintly stained ones. Focal accumulation of neuroglial cells and ballooned nerve cells of the cerebral cortex were also detected. Cleaved caspase-3, glial fibrillary acidic protein, and ionized calcium-binding adaptor molecule 1 showed substantial increases, while synaptophysin expression was significantly reduced. Interestingly, these changes were less prominent in mice pretreated with betahistine. In conclusion, betahistine had shown neuroprotective properties against brain damage induced by convulsions.
In late 2019, a novel coronavirus was detected in Wuhan, China, that caused a pandemic by September 2021, resulting in 224,180,411 cases and more than 4,600,000 deaths worldwide. In response to the pandemic, the Autonomous Kurdistan Regional Government of Iraq (KRG) imposed strict infection control measures at its borders for all travelers from neighboring countries, wherein each traveler was subjected to a mandatory reverse transcription polymerase chain reaction (RT-PCR) test on arrival to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected travelers. The aim of this study is to determine the rate of infection with SARS-CoV-2 among the travelers entering Kurdistan region through Ibrahim Al-Khalil crossing point with Turkey as a predictor for the upcoming infection waves.
The data of RT-PCR tests to detect SARS-CoV-2 in all travelers arriving at the Ibrahim Al-Khalil Border Crossing between Iraq and the Republic of Turkey were reviewed from August 21, 2020 to August 21, 2021.
It was found that there were 9873 cases of SARS-CoV-2 infections among 1,082,074 travelers during the study period.
This study shows the importance of mass testing of travelers at border crossings to control the spread of SARS-CoV-2 infection.
In numerous countries, emergency medical services (EMS) students receive curriculum training in effective patient–provider communication, but most of this training assumes patients have intact communication capabilities, leading to a lack of preparedness to interact with patients, who have communication disorders. In such cases, first responders could end up delivering suboptimal care or possibly wrong procedures that could harm the disabled person.
A quasi-experimental design (pretest–posttest) was used to assess the knowledge of EMS students both before and after a translation workshop on how to deal with patients who have hearing and communication disorders during emergencies. Comparisons between pretest and posttest scores were examined using the Wilcoxon signed rank test. The level of knowledge scores was compared before and after the workshop.
The results indicated that EMS students’ scores improved after the workshop. There was a 0.763 increase in the average score of knowledge level. The results of this study show that knowledge translation workshops are a useful intervention to enhance the level of knowledge among EMS students when interacting with hearing and communication patients.
Our results show that such training workshops lead to better performance. Communication is a vital element in a medical encounter between health care providers and patients at all levels of health care but specifically in the prehospital arena. Insufficient or lack of communication with a vulnerable population, who may suffer from various disabilities, has a significant impact on the outcome of treatment or emergency management.
To evaluate nursing staff’ perception of hospital readiness for continuity of essential health care services and surge capacity in line with COVID-19.
A total of 300 nurses were recruited from one hospital in Saudi Arabia. They completed self-administered, online questionnaires. The questionnaire assessed participants’ socio-demographic data and their perceptions regarding hospital readiness for continuity of essential health care services and surge capacity in line with COVID-19.
The findings revealed that nursing staff had a moderate mean score regarding hospital readiness for continuity of health care services (3.89 ± 0.61) and an average mean value regarding surge capacity of 3.83 ± 0.63. Also, the value of R2 of surge capacity in healthcare can predict 82.9% of the variance in hospital readiness for continuity of health care services in terms of surge capacity.
Hospital administrators could propose hospital regulations and protocols for the management of confirmed and suspected COVID-19 patients in addition to designing a continuing education program for health professionals at all levels related to prevention, control, and management of COVID-19 suspected and confirmed patients.
The development of an ovarian follicle is a complex process at the cellular and molecular level that is mainly regulated by follicle-stimulating hormone receptor (FSHR) and luteinizing hormone receptor (LHR). To elucidate the contribution of these receptors to ovarian follicle development, it is necessary to determine their expression profiles during this biological process. Therefore, this study aimed to investigate the relationship between ovarian development pattern and the differential ovarian expression pattern of FSHR and LHR genes as well as proteins at different developmental stages. Ovaries were collected from 30 New Zealand rabbits at day 0 (birth), week 2 (neonate), week 4 (cub), week 16 (maturity), and day 18 pregnancy. Ovarian histology, and gene as well as protein expression were determined using light microscopy, real-time PCR and western blotting, respectively. The results showed that the expression levels of FSHR mRNA and protein increased coincidently with age and the growth of ovarian follicles. The levels of LHR mRNA and protein remained low from the day of birth until week 4 and became significantly higher by week 16 coinciding with appearance of growing and antral follicles, which have a defined thecal layer. FSHR gene and protein expression decreased with pregnancy, whereas LHR increased, reaching a peak level during pregnancy. It can be concluded that changes in FSHR and LHR gene and protein expression could be related to the growth and development of follicles, indicating the regulatory role for these receptors in rabbit folliculogenesis.
Dromedary camel (Camelus dromedarius) is adapted to survive the harsh environments. It has some key adaptation peculiarities in various organs. In this study, we aimed to map the distribution pattern of unique regulatory devices along the course of the pulmonary vessels using histological and histochemical analyses. Arteries with variable wall thickness and spirally oriented course were recorded within the adventitia of the main pulmonary artery. Throttle arteries and glomus bolsters were found within the wall of the lobar pulmonary artery. The bronchial artery was located within the wall of all bronchi reaching the subsegmental branches and it had elastic longitudinal muscular intima bolsters. Arteries with double muscular media were demonstrated in the pulmonary pleura. These bolsters are suggested to play a complicated role that allows for hemodynamic, humeral, and thermoregulatory activities. The lumen of some subsegmental pulmonary veins revealed occasional constrictions arising from the corresponding muscular pad-like protrusions of the tunica media. These veins may possess occlusive or constrictive mechanisms and their obstruction induces engorgement of the associated capillary bed in addition to restricting venous outflow. Collectively, these data strongly recommend a crucial role for the special regulatory devices in preserving the camel pulmonary function in the harsh desert environment.
For autocrats ruling over religious populations as in many Muslim majority countries, threats of mass collective action and religious mobilization are risky to ignore, being potentially detrimental to authoritarian survival. Religious seasons, such as Ramadan, could raise the seriousness of such threats. Accordingly, incumbents might adopt expansionary fiscal policies to avoid the escalation of political discontent at these times. Focusing on Egypt's fiscal policy between 2006 and 2019, I find that although the religious season of Ramadan is associated with modest increases in government expenditure and welfare spending, this relationship is dependent on the level of political threats facing the regime. Government spending is higher in Ramadan's season when it is preceded by more episodes of anti-regime collective action. This evidence suggests that the interaction between the religious and political contexts could generate political budget cycles outside electoral seasons.
In this article, a novel double-face logarithmic spiral metamaterial (LSMTM) superstrate-inspired multiple-input multiple-output (MIMO) for fully enhanced circularly polarized (CP) antenna system is examined for 5G wireless communications. This novel double-face LSMTM superstrate acts as a planar concave-concave lens. Initially, the antenna is designed with a circular spiral patch to generate CP radiation in the frequency band of interest. Then, at a height of 6.5 mm (0.606 λo) above the MIMO antenna, which has a 0.8 mm (0.075 λo) edge-to-edge separation, the LSMTM superstrate is employed for isolation, gain, and bandwidth improvement. The proposed superstrate enhances the isolation, gain, and bandwidth of the antenna by about 32 dB, 3.47 dB, and 900 MHz, respectively. In contrast to the conventional technique of verifying operation with a simulated surface current distribution, characteristic mode analysis (CMA) is used to provide a better explanation of the proposed antenna's different modes and the creation of circular polarization. Additionally, the CMA supports the development of an effective technique that can predict whether or not the isolation can be further improved. The simulated results align with the measured results and are well adapted for 5G wireless communication devices.
This cross-sectional study was designed to establish diagnostic accuracy of the Patient Health Questionnaire 2 in Qatar’s primary care population. The data required for the study were anonymously extracted from Qatar’s primary care electronic medical record system. The sensitivity, specificity, predictive values, negative values and optimal cut-off points were calculated for the tool. A total of 6921 individuals met the study’s inclusion criteria. The diagnostic accuracy of cut-off values was calculated for scores 1–6. Based on the Youden’s index (0.58), a score of 2 was identified as the most optimal cut-off. It offers a sensitivity of 88.73% and specificity of 69.31%. Further studies should aim to confirm the results using alternative study designs and to report them in accordance to population characteristics both in Qatar and internationally.
Strategies to modulate the tumor microenvironment (TME) have opened new therapeutic avenues with dramatic yet heterogeneous intertumoral efficacy in multiple cancers, including glioblastomas (GBMs). Therefore, investigating molecular actors of TME may help understand the interactions between tumor cells and TME. Immune checkpoint proteins such as a Cluster of Differentiation 80 (CD80) and CD86 are expressed on the surface of tumor cells and infiltrative tumor lymphocytes. However, their expression and prognostic value in GBM microenvironment are still unclear.
In this study, we investigated, in a retrospective local discovery cohort and a validation TCGA dataset, expression of CD80 and CD86 at mRNA level and their prognostic significance in response to standard of care. Furthermore, CD80 and CD86 at the protein level were investigated in the discovery cohort.
Both CD80 and CD86 are expressed heterogeneously in the TME at mRNA and protein levels. In a univariate analysis, the mRNA expression of CD80 and CD86 was not significantly correlated with OS in both local OncoNeuroTek dataset and TCGA datasets. CD80 and CD86 mRNA high expression was significantly associated with shorter progression free survival (PFS) (p < 0.05). These findings were validated using the TCGA cohort; higher CD80 and CD86 expressions were correlated with shorter PFS (p < 0.05). In multivariate analysis, CD86 mRNA expression was an independent prognostic factor for PFS in the TCGA dataset only (p < 0.05).
CD86 could be used as a potential biomarker for the prognosis of GBM patients treated with immunotherapy; however, additional studies are needed to validate these findings.
Trichinosis is a serious zoonotic disease that causes human morbidity and mortality. New effective natural remedies with minimal side effects that are well tolerated are needed to treat both enteral and parenteral trichinosis. This study evaluated the efficacy of selenium (Se), Se nanoparticles (SeNPs) and Egyptian propolis compared with albendazole as antiparasitic, anti-inflammatory and anti-angiogenic agents for treating murine trichinosis. We used parasitological, histopathological and immunohistochemical assays, as well as scanning electron microscopy, to examine adult worms. Overall, 80 Swiss albino male mice were divided into eight groups, with ten mice in each group, as follows: negative control, positive control, albendazole, propolis, Se, combination of propolis and Se, SeNPs and combination of SeNPs and propolis. Mice were slaughtered seven and 35 days after infection to examine the intestinal and muscular phases, respectively. This study demonstrated the efficacy of the combination of SeNPs and propolis. As revealed by electron microscopy, this combination caused damage to the adult worm cuticle. Additionally, compared with albendazole, it resulted in a significant reduction in adult worm and total larval counts; moreover, it caused a decrease in the number of larvae deposited in muscles, with a highly significant decrease in the inflammatory cell infiltrate around the larvae and a considerable decrease in the expression of the angiogenic marker vascular endothelial growth factor in muscles. In conclusion, the combination of SeNPs and propolis had antiparasitic, anti-inflammatory and anti-angiogenic effects on trichinosis. Consequently, this combination could be used as a natural alternative therapy to albendazole for treating trichinosis.
Durable materials for Nzi traps were tested in three applied settings based on promising formats that were tested first in Canada. Experiments were conducted at Cape Cod, Massachusetts, United States of America at the site of a major tabanid control programme and at two challenging tropical locations (Sudan and Philippines) where mechanical transmission of trypanosomiasis occurs. At Cape Cod, royal blue–painted plywood Nzi traps caught up to 19 times as many tabanids as greenhead box traps used locally did. Fabric Nzi traps caught up to six times more horseflies, Tabanus spp. (Diptera: Tabanidae), than a box trap did and twice as many horseflies than a popular commercial trap, the Horse Pal® did. A home-dyed phthalogen turquoise cotton trap also performed well. In the Philippines, it caught 2.5 times as many Tabanus as a standard phthalogen blue cotton trap did. Durable phthalogen blue Sunbrella acrylic and Top Notch polyester traps with various types of netting performed well at all locations.
All textile integrated dual-band monopole antenna with an artificial magnetic conductor (AMC) is proposed. The proposed design operates at 2.4 and 5.8 GHz for wearable medical applications to monitor the heartbeat. A flexible and low-profile E- shaped CPW dual-band textile antenna is integrated with a 4 × 4 dual-band textile AMC reflector to enhance the gain and specific absorption rate (SAR). The SAR is reduced by nearly 95% at both 1 and 10 g. The design was measured on the body with a 2 mm separation. The simulated and measured results appear in high agreement in the case of with and without AMC array integration. The measurement was performed in the indoor environment and in an anechoic chamber to validate the design based on reflection coefficient and radiation pattern measurements.
Yasui procedure is surgical repair intended to preserve biventricular function for patients with left ventricle outflow tract obstruction associated with aortic arch lesions and ventricular septal defect.
Retrospective chart review analysis of all patients who had Yasui procedure (2008–2020) comparing midterm outcome of one versus two stage repair.
Twenty patients (70% female) underwent Yasui procedure in our center. Eight patients (40%) had left ventricle outflow tract obstruction /interrupted aortic arch, 7 patients (35%) had left ventricle outflow tract obstruction /coarctation of aorta, 3 patients (15%) had double outlet ventricle and ventricular septal defect that were unattainable for tunneling to one of the semilunar valves without creating obstruction, and 2 patients (10%) had aortic atresia with hypoplastic aortic arch. All patients had associated ventricular septal defect. Fifteen patients (75%) had one-stage repair and 5 patients (25%) had two-stage repair. Means age and weight for one and two-stage repair were 1.3 ± 2 months, 13.4 ± 11.5 months and 3.3 ± 0.6 kg, 7.8 ± 3.4 kg, respectively. During follow up, 8 patients (40%) required re- intervention, mainly for right ventricle–pulmonary artery conduit either dilation or replacement. The average duration of follow up was 5 years with nil mortality.
Yasui procedure is effective approach for children who have left ventricle outflow tract obstruction associated with aortic arch anomalies and ventricular septal defect. Survival rate with single or staged repair is comparably good. During the first 5 year of follow up, nearly 40% of operated patients required re-intervention.