Don’t Miss the Target

NON

Factors Affecting Early Maturation of Arteriovenous Fistulae Created at a Tertiary Centre in Oman

Objectives: An arteriovenous fistula is ideal for vascular access, the maturation of which is vital for hemodialysis. Our aim was to determine the risk factors associated with failure of maturation of arteriovenous fistulae. Methods: This retrospective cohort study, from January 2014 to December 2018 was conducted in a tertiary care hospital in Oman, Patients were followed up for three months after surgery. Electronic medical records were accessed for demographics and clinical data. Data was analyzed using SPSS package. Univariant analysis was used to determine the risk factors associated with early maturation of AVF and multi variant analysis used to determine the predictive risk factors. Results: There were a total of 269 patients in the study. Female gender was a significant factor affecting maturity (P= 0.027). While factors not affecting maturation were age (P= 0.320), diabetes (P= 0.858), hypertension (P= 0.215), dyslipidemia (P= 0.215), coronary artery disease (P= 0.433), cerebrovascular accident (P= 0.864), congestive heart failure (P= 0.509), previous central venous catheter creation (P= 0.11), fistula type (P= 0.863) and fistula side (P= 0.861). Binary logistic regression showed that all risk factors were insignificant. Failure of early maturation was 11.5%. Conclusion: Our research has shown that the early maturation proportion of arteriovenous fistulae created at our hospital is at par with international literature.  Failure of maturation was significantly associated with the female gender. Results of this study can help nephrologists and vascular surgeons prognosticate maturation rates of arteriovenous fistulae. However, a larger study is needed for definitive conclusions. Keywords: CKD; AVF; maturation; early; failure; Oman

Role of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists in Hypoglycemia

A relatively recent addition to the arsenal of antidiabetic drugs used for the treatment of type 2 diabetes mellitus (T2DM) has been the “incretin mimetics,” a group of drugs that work on the glucagon-like peptide-1 (GLP-1) receptor and enhance insulin secretion from the pancreatic β-cells in a glucose-dependent manner, more potently in hyperglycemic conditions, while suppressing glucagon secretion at the same time. Therefore, it was assumed that this class of drugs would have a lower risk of hypoglycemia than insulin secretagogues like sulphonylureas. However, GLP-1 receptor agonists have been proposed to cause hypoglycemia in healthy normoglycemic subjects implying that their action is not as glucose-dependent as once thought. Other studies concluded that they might not induce hypoglycemia and the risk is dependent on other individual factors. However, the FDA announced that the 12 GLP-1 receptor agonists currently available on the market had potential safety signs and evaluated the need for regulatory action. This review provides an overview of the studies that investigated the possible hypoglycemic effect of GLP-1 receptor agonists. In addition, the current review describes other adverse effects of GLP-1 receptor agonist treatment

Effect of intracoronary glycoprotein IIb/IIIa inhibitor and manual aspiration thrombectomy on primary percutaneous coronary intervention outcome in high thrombus burden patients

Background: The opening of a related artery in myocardial infarction as quickly as possible is the key to treating infarct. Percutaneous coronary intervention (PCI) for recanalization of related infarcted arteries is considered the most effective therapy for myocardial infarction.Objective: To estimate the intracoronary delivery of glycoprotein IIb/IIIa following manual thrombus aspiration on outcomes post PCI for patients with high thrombus burden.Patients and Methods: This was a randomized control trial that was conducted on 48 patients presented to Zagazig University Hospital Emergency Cardiac Unit with ST elevation myocardial infarction for primary percutaneous coronary intervention, the need for reperfusion therapy was assessed according the European Society of Cardiology (ESC) Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Patients were randomized into three groups: (1) Manual aspiration group (16 patients). (2) Manual aspiration with intracoronary glycoprotein IIb/IIIa group (19 patients), and (3) Intracoronary glycoprotein IIb/IIIa group (13 patients).Results: There was significant difference between manual aspiration group, manual aspiration with intracoronary glycoprotein IIb/IIIa group and intracoronary glycoprotein IIb/IIIa group as regard the outcomes in high thrombus burden patients.Conclusion: Combination glycoprotein IIb/IIIa and manual aspiration is better then single modality for high thrombus burden patients

Biomaterials in Traumatic Brain Injury: Perspectives and Challenges

Traumatic brain injury (TBI) is a leading cause of mortality and long-term impairment globally. TBI has a dynamic pathology, encompassing a variety of metabolic and molecular events that occur in two phases: primary and secondary. A forceful external blow to the brain initiates the primary phase, followed by a secondary phase that involves the release of calcium ions (Ca2+) and the initiation of a cascade of inflammatory processes, including mitochondrial dysfunction, a rise in oxidative stress, activation of glial cells, and damage to the blood–brain barrier (BBB), resulting in paracellular leakage. Currently, there are no FDA-approved drugs for TBI, but existing approaches rely on delivering micro- and macromolecular treatments, which are constrained by the BBB, poor retention, off-target toxicity, and the complex pathology of TBI. Therefore, there is a demand for innovative and alternative therapeutics with effective delivery tactics for the diagnosis and treatment of TBI. Tissue engineering, which includes the use of biomaterials, is one such alternative approach. Biomaterials, such as hydrogels, including self-assembling peptides and electrospun nanofibers, can be used alone or in combination with neuronal stem cells to induce neurite outgrowth, the differentiation of human neural stem cells, and nerve gap bridging in TBI. This review examines the inclusion of biomaterials as potential treatments for TBI, including their types, synthesis, and mechanisms of action. This review also discusses the challenges faced by the use of biomaterials in TBI, including the development of biodegradable, biocompatible, and mechanically flexible biomaterials and, if combined with stem cells, the survival rate of the transplanted stem cells. A better understanding of the mechanisms and drawbacks of these novel therapeutic approaches will help to guide the design of future TBI therapies

مدى تأثير الأحاديث الضعيفة والموضوعة على دور المرأة وتمكينها في المجتمع دراسة ميدانية على عينة من طلاب وطالبات جامعات دولة قطر

إنه مما لا شك فيه أن علاقة الرجل بالمرأة تتعرض لمؤثرات عدة: ثقافية، واجتماعية، وسياسية، مما قد يكون له بالغ الأثر على هذه العلاقة بالإيجاب أو السلب. وتعد الأحاديث الضعيفة والموضوعة من الروافد الثقافية التي لها علاقة بطبيعة الاتجاه نحو المرأة في المجتمعات الإسلامية وتمكينها الإيجابي في المجتمع؛ لاحتوائها على مجموعة من المفاهيم والأدبيات التي تؤثر في العقل المسلم، والتي استوطنت فيه قرونًاا لازالت أنفاسها تظهر من هنا وهناك على شكل تيارات فكرية، تنادي باختزال أدوار المرأة المتعددة في المجتمع في دور أوحد -مع أولويته- وهو بيتها؛ لتقر فيه جاهلة لا نصيب لها من علم، ولا حظ لها من ثقافة. وقد تُرَسِّخُ هذه الأحاديث الضعيفة والموضوعة الكثير من السلوكيات والتصرفات تجاه المرأة والحيلولة دون تمكينها الإيجابي في المجتمع، انطلاقًاا من القناعة الفكرية بهذه الأحاديث وجدواها، كما تَكْمُن خطورة مثل تلك الأحاديث عندما يتم تطبيقها بصورة عملية من أفراد المجتمع دون التأكد من صحتها أو ثبوتها، كما أن هذا لا ينفى احتمالية وجود فئةٍ معينةٍ تأخذ من هذه الأحاديث ما يوافق مزاجها الفكري، أو تقاليدها المتبعة، أو أعرافها المستقرة، وتعمل على إلباس هذا الفكر وتلك التقاليد القداسة والشرعية مما قد يؤثر بالسلب على مكانة المرأة وتمكينها في المجتمع المسلم. ومما تهدف إليه الدراسة ١-  قياس المدى المعرفي لهذه الأحاديث من حيث تواجدها ومدى صحتها لدى عينة البحث والمصادر التي تنتشر من خلالها. ٢-  قياس مدى التَأَثُّر بالأحاديث الضعيفة والموضوعة والتي وجَّهت الأمة قرونًاا طويلنًا في الاتجاه السلبي نحو المرأة وحالت دون تمكينها بشكل إيجابي في المجتمع. ٣-  الرغبة في إدماج المرأة في المسار التنموي العام إدماجاً إيجابياً وعادلاً. ٤-  السعي في عودة الوعي الفكري الصحيح في هذه القضية لمواجهة مزاعم الانتقاص من مكانة المرأة ودورها المجتمعي في الشريعة الإسلامية. ٥-  الإسهام في زيادة الوعي للحيلولة دون وقوع التصدع الأسري نتيجة العمل بهذه الأحاديث والذي يؤثر سلبا على الاستقرار الأسري للمجتمع. ٦-  بيان ضعف وزيف بعض المؤثرات الثقافية التي قد تحول دون دمج المرأة في مؤسسات المجتمع وتمكينها من أداء دورها المجتمعي. ٧-  تنقية الجانب الثقافي عند طلاب الجامعات يعد دعما للثقافة التي تميز دولة قطر من خلال ترسيخ القيم والمبادئ العربية والإسلامية الصحيحة والتي تضمن السلم والأمن الاجتماعي والاستقرار داخل المجتمع القطري. ٨-  تعزيز مكانة الثقافة العربية الإسلامية في نفوس طلاب الجامعات في دولة قطر من خلال تنقية هذه الثقافة مما شابها وكدرها. واستخدم الباحثون المنهج الوصفي التحليلي في إجراء هذا البحث، ويهدف المنهج الوصفي التحليلي إلى رصد الظاهرة موضع البحث بدون أي تدخل من الباحثين، ووصفها وصفاً دقيقاً من حيث جوانب القوة والضعف الموجودة في ظاهرة البحث، ثم تحليل هذه المعلومات من أجل تفسير هذه الظاهرة بصورة علمية. ويتم تنفيذ الدراسة التطبيقية المقصودة عن طريق عينة عشوائية حجمها ٦٠٠ طالب وطالبة بواقع ١٠٠ لكل باحث من الطلاب وعددهم ستة: ثلاث من البنين، وثلاثة من البنات؛ ليقوم الطلاب بعمل الدراسة مع البنين وتقوم الطالبات بعمل الدراسة مع البنات. وهذه العينة تكون ممثلة للشباب في جامعات دولة قطر (جامعة قطر الوطنية - كلية المجتمع - وغيرها من الجامعات في دولة قطر) ويتم تحديد نسب الطلاب والطالبات في كل جامعة بنااً على نسب التمثيل العددي لكل جامعة. وخلص الجانب النظري إلى ١-  علاقة الرجل بالمرأة تتأثر بالمتغيرات الثقافية والاجتماعية والسياسية السائدة في المجتمع. ٢-  تنوع الأحاديث الموضوعة والضعيفة وكثرتها واتساعها لتشمل الكثير من قضايا المرأة ومكانتها في الأسرة وكيفية التعامل معها في الأحوال المختلفة وهذا أحدث لباًا للحق بالباطل واختلااًا للصواب بالخطأ. ٣-  الأحاديث الموضوعة تؤدي إلى إلباس الفكر المنحرف تجاه المرأة ثوب القداسة والشرعية. ٤-  السعي في عودة الوعي الفكري الصحيح في هذه القضية من شأنه القضاء على مزاعم انتقاص المرأة لحقوقها ودورها في الدين الإسلامي. ٥-  لا يقتصر دور المرأة داخل محيطها الأسري وإنما يتجاوزه إلى رعاية المجتمع كما هي رعاية الأبناء والأسرة تمااًا. ٦-  المشاركة الإيجابية للمرأة في المجتمع هو أساس أي تقدم اجتماعي؛ لذا من الضروري تأهيل المرأة وإعادتها لسابق دورها من النشاط والحيوية والتفاني في خدمة مجتمعها. ٧-  التنازل عن دور المرأة هو تنازل طوعي عن قدرات نصف المجتمع والتأثير في قدرات النصف الآخر. ٨-  التعرف على الواقع الفعلي لدور المرأة هو السبيل الوحيد للعمل على نيل المرأة لحقوقها وتبوؤ مكانتها دون منة من المجتمع. وتوصي الدراسة في جانبها النظري بضرورة إجراء مثل هذه الدراسات لبحث مدى تأثُّر دور المرأة في المجتمع بالمؤثرات الثقافية التي لها دور في التعامل السلبي مع المرأة. وأما الجانب التطبيقي للدراسة فمن المتوقع الانتهاء منه وتحليل نتائجه وسيتم تضمينه في الدراسة قبيل موعد عقد المؤتمر بعون الل

Comparing low-dose (DART) and enhanced low-dose dexamethasone regimens in preterm infants with bronchopulmonary dysplasia

IntroductionDetermining the optimal dexamethasone dosage for facilitating extubation in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) remains uncertain. This study aims to compare the effectiveness of low-dose (DART) and enhanced low-dose dexamethasone regimens in achieving successful extubation in these infants.MethodsWe conducted a retrospective cohort study at the Women's Wellness and Research Center (WWRC) involving ELBW infants who received dexamethasone for BPD prevention or treatment, or for extubation between January 1st, 2015, and December 31st, 2019. Our goal was to assess successful extubation within various time points of treatement.ResultsA total of 77 patients, matched in gestational age and BW, were enrolled in the study, receiving a total of 121 dexamethasone courses. Low-dose dexamethasone courses were administered 75 times to 49 infants, while 46 courses of enhanced low-dose were given to 28 infants. Treatment commenced at 30.8 ± 3.4 weeks post-menstrual age, compared to 32.1 ± 2.5 weeks in the enhanced low-dose group (p = 0.014). The median (IQR) course duration was seven (3–10) days in the low-dose group, while it was 10 (8–14) days in the enhanced low-dose group (p < 0.001). The median (IQR) course dose was 0.73 (0.53–0.86) mg/kg in the low-dose group and 1.27 (0.97–2.05) mg/kg in the enhanced low-dose group (p < 0.001). There were no differences in extubation success at any time point between the two groups at 72 h and seven days after treatment initiation, by course completion, and within seven days after treatment completion. However, regression analysis identified several predictors of successful extubation; baseline FiO2, course duration, and duration of invasive mechanical ventilation were negatively associated with successful extubation at various time points, while received dose per kg and cumulative dose positively correlated with successful extubation at different time points. No significant differences were observed in secondary outcomes, including death or BPD.ConclusionThe choice between low-dose and enhanced low-dose dexamethasone regimens may not significantly impact extubation success. However, careful consideration of dosing, ventilation status, and treatment duration remains crucial in achieving successful extubation. This study highlights the need for personalized dexamethasone therapy in ELBW infants

Factors Influencing Public Attitudes towards COVID-19 Vaccination: A Scoping Review Informed by the Socio-Ecological Model

Major hindrances to getting a COVID-19 vaccine include vaccine hesitancy, skepticism, refusal, and anti-vaccine movements. Several studies have been conducted on attitudes of the public towards COVID-19 vaccines and the potential influencing factors. The purpose of this scoping review is to summarize the data available on the various factors influencing public attitudes towards COVID-19 vaccination. This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. PubMed, Embase, Web of Science, and Cochrane Central were searched without restrictions to reclaim all publications on the factors that shape individuals’ attitudes towards COVID19 vaccines from 1 January 2020 to 15 February 2021. Fifty studies were included. The scoping review revealed that the factors influencing public attitudes towards COVID-19 vaccines were embedded within the different levels of the socio-ecological model. These factors included the sociodemographic characteristics of the individuals, individual factors, social and organizational factors. In addition, certain characteristics of COVID-19 vaccines themselves influenced public attitudes towards accepting the vaccines. Understanding various population needs and the factors shaping public attitudes towards the vaccines would support planning for evidence-based multilevel interventions in order to enhance global vaccine uptake

Salvage Cryotherapy for Radiation-Recurrent Prostate Cancer: Outcomes and Complications

Potentially curative salvage options for radio-recurrent prostate cancer include prostatectomy, brachytherapy, high-intensity focused ultrasound, and cryotherapy. Salvage cryoablation technology, surgical technique, oncologic outcomes, and complication rates have improved dramatically over the past few decades, shifting this treatment modality from investigational status to an established therapeutic option. In this review, we focus on the most up-to-date oncologic and functional outcomes, as well as complications of salvage cryotherapy for radiation-recurrent prostate cancer

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London