Asthma diagnosis and treatment - 1012. The efficacy of budesonide in the treatmetn of acute asthma in children: a double-blind, randomized, controlled trial.

Background Current evidence suggests that inhaled glucocorticoids (IGC) have a more profound topical none genomic effect on bronchial airways as compared to systemic glucocorticoids. The value of adding IGC to current therapy of acute asthma is not well established. Methods We conducted a double-blind, randomized, two-arm, parallel groups, controlled clinical trial to compare the addition of budesonide 1500 mcg or placebo (normal saline) to standard acute asthma treatment (albuterol and ipratropium bromide) administered in 3 divided mixed doses within 1 hour in the emergency department (ED). Children 2-12 years of age with moderate or severe acute asthma, scoring 8-15/15 on a well-validated scoring system were included. Both groups received a single dose of prednisone 2 mg/kg/day (max. 60 mg) at the beginning of therapy. The primary outcome was admission rate within 2-4 hours from starting therapy. Results A total of 723 children were enrolled in the study over 17 months duration, of whom 139 were allowed to re-enroll and be randomized to constitute 906 randomization assignments (458 on the treatment group and 448 on the control group); with baseline mean + SD asthma score of 10.63 + 1.73; age 5.52 + 2.76 years; 35% girls; 30.8% (16.5%) with baseline severe asthma score of ≥12 (≥ 13). Statistical Analysis plan allowed for the potential dependency in response due to reenrollments of a subset of children, using Generalized Linear Mixed Modeling (GLMM) techniques. Baseline demographic and clinical characteristics were not significantly different between the two randomized groups. Seventy-five out of 458 (16.4%) of the treatment group vs. 82/448 (18.3%) of the control group were admitted, (OR 0.85, CI: 0.59-1.23, p-value=0.39). Among the severe asthmatics with baseline score ≥13, treatment vs. placebo group, GLMM adjusted admission rate was 30% vs. 47%, indicating a 17% difference in admission rate in favor of the treatment group (adjusted OR of 0.49, CI: 0.25-0.95; p-value= 0.035) that indicated a 51% reduction in the risk of admission for the treatment vs. control group. Conclusions Children with baseline severe asthma score ≥13 who were treated with budesonide had a significant reduction in their admission rate

Evaluation on Cooling Energy Load with Varied Envelope Design for High-Rise Residential Buildings in Malaysia

With the development of the economy in the recent years, Malaysia is maintaining a high economic growth and therefore, its energy consumption increases dramatically. Residential buildings are characterized by being envelope-load dominated buildings, hence are greatly influenced by the outside climatic conditions. Due to the hot humid climate of Malaysia, air conditioning system accounts for more than 45% of the total electricity used in the residential sector which is required to remove substantial amount of gained heat due to poor thermal envelope performance. This paper uses Ecotect software to analyze the impact of building envelope design on energy cooling load for residential building in Penang, Malaysia, which include area ratio of window to floor, exterior wall thermal insulation, and several kinds of shading system. This paper describes an integrated passive design approach to reduce the cooling requirement for high-rise apartments through an improved building envelope design. Comparing with the other passive strategies investigated in this paper, the results indicated that exterior wall thermal insulation is the best strategy to decrease both annual cooling energy load and peak cooling load which achieved a reduction of 10.2% and 26.3% respectively. However, the other passive strategies applied also have some marginal effect on decreasing the cooling load

Naji Al-Hamshari Mosque in Amman and “Electronic Baroque” Architecture

The architecture of modern Jordan is located at the intersection of traditions of Western and Eastern cultures. Computer technologies create the concept of nonlinear architecture and change the architecture of modern mosques. The analysis of the al-Hamshari mosque in Amman shows the im­pact of “electronic Baroque” architecture on Islamic architecture not only in terms of modern design solutions, but also as an opportunity to identify new semantic shades in religious architecture.Архитектура современной Иордании находится на пересечении традиций западных и восточных культур. Компьютерные технологии формируют концепцию нелинейной архитектуры и меняют облик современных мечетей. Анализ мечети Аль-Хамшари в Аммане показывает воздействие архитектуры «электронного барокко» на исламскую архитектуру не только с точки зрения современного дизайнерского решения, но и как возможности выявить в религиозной архитектуре новые смысловые оттенки

Assessment of multiple choice question exams quality using graphical methods

Exams should be valid, reliable, and discriminative. Multiple informative methods are used for exam analysis. Displaying analysis results numerically, however, may not be easily comprehended. Using graphical analysis tools could be better for the perception of analysis results. Two such methods were employed: standardized x-bar control charts with standard error of measurement as control limits and receiver operator characteristic curves. Exams of two medical classes were analyzed. For each exam, the mean, standard deviation, reliability, and standard error of measurement were calculated. The means were standardized and plotted against the reference lines of the control chart. The means were chosen as cut-off points to calculate sensitivity and specificity. The receiver operator characteristic curve was plotted and area under the curve determined. Standardized control charts allowed clear, simultaneous comparison of multiple exams. Calculating the control limits from the standard error of measurement created acceptable limits of variability in which the standard deviation and reliability were incorporated. The receiver operator characteristic curve graphically showed the discriminative power of the exam. Observations made with the graphical and classical methods were consistent. Using graphical methods to analyse exams could make their interpretation more accessible and the identification of exams that required further investigation easier

Very low prevalence of epidermal growth factor receptor (EGFR) protein expression and gene amplification in Saudi breast cancer patients

<p>Abstract</p> <p>Background</p> <p>Breast cancers which demonstrate EGFR protein expression, gene amplification and/or gene mutations may benefit therapeutically from tyrosine kinase inhibitors. In Western studies, EGFR protein expression has been demonstrated in 7-36% of breast cancer patients, while gene amplification has been found in around 6% of cases and mutations were either absent or extremely rare. Studies addressing EGFR protein expression and gene amplification in Saudi breast cancer patients are extremely scanty and the results reported have been mostly non-conclusive. Herein we report the prevalence of EGFR protein expression and gene amplification in a cohort of Saudi breast cancer patients.</p> <p>Findings</p> <p>We noticed a remarkably low incidence of EGFR protein expression (1.3%) while analyzing the spectrum of molecular subtypes of breast cancer in a Saudi population by immunohistochemistry. Also, <it>EGFR </it>gene amplification could not be demonstrated in any of 231 cases studied using silver enhanced <it>in situ </it>hybridization.</p> <p>Conclusions</p> <p>The extremely low incidence of EGFR protein expression and gene amplification in Saudi breast cancer patients as compared to Western populations is most probably ethnically related as supported by our previous finding in the same cohort of a spectrum of molecular breast cancer types that is unique to the Saudi population and in stark contrast with Western and other regionally based studies. Further support to this view is provided by earlier studies from Saudi Arabia that have similarly shown variability in molecular breast cancer subtype distribution between Saudi and Caucasian populations as well as a predominance of the high-grade pathway in breast cancer development in Middle East women. More studies on EGFR in breast cancer are needed from different regions of Saudi Arabia before our assumption can be confirmed, however.</p

3-(Adamantan-1-yl)-4-methyl-1-[(4-phenyl­piperazin-1-yl)meth­yl]-1H-1,2,4-triazole-5(4H)-thione dichloro­methane hemisolvate

The asymmetric unit of the title dichloro­methane hemisolvate, C24H33N5S·0.5CH2Cl2, comprises an adamantan­yl/triazole derivative and half a CH2Cl2 mol­ecule of crystallization; the latter is disordered about a twofold axis of symmetry. The piperazine ring has a chair conformation and the two N-bound substituents occupy equatorial positions. The piperazine residue is almost normal to the triazole ring [N—N—C—N torsion angle = −79.9 (3)°] so that to a first approximation, the mol­ecule has an L-shape. Linear supra­molecular chains parallel to [001] are formed via C—H⋯S inter­actions. Two such chains are linked into a double chain via C—H⋯Cl inter­actions involving the disordered CH2Cl2 mol­ecules of solvation

3-(Adamantan-1-yl)-1-[(4-benzyl­piperazin-1-yl)meth­yl]-4-[(E)-(2-hy­droxy­benzyl­idene)amino]-1H-1,2,4-triazole-5(4H)-thione

In the title compound, C31H38N6OS, the conformation about the N=C [1.285 (2) Å] imine bond is E. The piperazine ring has a chair conformation and occupies a position almost perpendicular to the plane through the triazole ring; the benzene ring forms a dihedral angle of 31.95 (10)° with the triazole ring. Overall, the mol­ecule has the shape of a flattened bowl. The hy­droxy group is disordered over two positions. The major component has a site-occupancy factor of 0.762 (3) and forms an intra­molecular O—H⋯N(imine) bond to close an S(6) loop. The minor component of the disordered hy­droxy group forms an O—H⋯N(piperazine) hydrogen bond. These, along with C—H⋯S and C—H⋯N inter­actions, link mol­ecules into a three-dimensional architecture

Effects of planting date and spraying with organic fertilizers on vegetative growth indices of dill plant (Anethum graveolens L.)

A factorial field experiment in a split-plot design was carried out in Kannan district, Diyala Governorate, mid-east of Iraq, during the agricultural season 2020-2021 to study the effect of planting date and spraying with organic fertilizers on growth and qualitative characteristics of dill plant (Anethum graveolens L.). The experiment included three replicates, each comprising 15 factorial treatments. Experiment factors included three planting dates (20/9, 10/10 and 1/11) and three types of organic fertilizers (humic fertilizers, seaweed extracts and amino acids). Organic fertilizers were sprayed three times during the vegetative growth stage. Results indicate that the plants growing on the first date (20/9) significantly outperformed in plant height, the number of leaves, chlorophyll content and dry matter percentage, which amounted to 42.48 cm, 5.8 leaf plant-1, 28.06 mg per 100 g fresh weight and 8.52%, respectively. The second date (10/10) were significantly superior in vegetative yield which amounted to 26.791ton ha-1. All fertilizers were significantly outperformed control treatment in plant height, the number of leaves and branches, chlorophyll percentage, vegetative yield and dry matter percentage

Referral Physicians’ Knowledge of Radiation Dose: A Cross-sectional Study

AIM: The purpose of the study was to evaluate the knowledge of referring physicians of general practitioners, residents, and medical specialists in Jordan and the Middle East on radiation dose and its impact on vulnerable patients. MATERIALS AND METHODS: The Institutional Review Board approved this study before data collection. A cross-sectional study employed questionnaire that was distributed to respondents (n = 293) of general practitioners, residents, specialists, and therapists. The questionnaire consisted of 29 questions. Nine questions concerned with demographics and the remaining 20 questions were divided into five sections: Radiation dose, ionizing radiation, pediatric radiation, pregnant women radiation, and radiation risks. The mean score was computed out of 20. Chi-squared test of independence was utilized to analyze each question. To compare the responses between the demographic variables groups, Kruskal–Wallis and Mann–Whitney tests were used. RESULTS: Out of the 293 respondents, 128 (43.7%) were aware of radiation. The average score of the questionnaire was 9.5 out of 20 (47.5%). Within each section, the level of knowledge varied. Physicians had the highest level of knowledge in radiation risk (85.7%) followed by ionizing radiation (62.1%). The questionnaire revealed lower levels of knowledge in the areas of pediatric radiation, pregnant women radiation, and radiation dose. The percentages of respondents, (with fair to good level of knowledge), were 47.1%, 34.5%, and 24.6%, respectively. CONCLUSION: The results of this study were consistent with previous studies that demonstrated a poor level of general knowledge in referring physicians regarding radiation dose, ionizing radiation, pediatric radiation, pregnant women radiation, and radiation risks