Correlations of complete blood count, liver enzyme and serum uric Acid in Sudanese pre-eclamptic cases

Background: Pre-eclampsia is a serious disorder of pregnancy with unknown ethological factors that may occur at any stage of second or third trimester of pregnancy. The objectives of the present study were to assess changes in complete blood counts including platelets, liver enzymes and serum uric acid in pre-eclamptic cases compared to second-half normal pregnant and non-pregnant Sudanese women and their correlations to other biomarkers.Methods: This was a cross-sectional, case-control study performed from December 2008 to December 2010; in Omdurman Maternity Hospital, in concomitance with other studies in pre-eclampsia. The sample size included three groups, 72 up pre-eclamptic cases in their recent pregnancies, 96 normal pregnant in their second half of pregnancy and 63 non- pregnant (control) women; a total of 231 subjects. Questionnaire Interviews and clinical examination were done for all participants. Laboratory investigations were done including complete blood picture, liver enzymes and uric acid.  Results: The mean Hb concentration of the pre-eclamptic (11.3g/dl±1.7) was statistically significantly lower than that of the non-pregnant (12.1g/dl±0.2) (P=0.01) but not from that of the normal pregnant (11.4g/dl±0.1) (P=0.882) .There was no statistical significant difference in the mean WBC count between the pre-eclamptic (7.4x103/mm3±0.3) and non-pregnant (7.3x103/mm3±0.3) (P=0.797) and between the pre-eclamptic and normal pregnant (7.7x103/mm3±0.2) (P=0.270). There was a considerable statistical significant decrease in the mean platelets count of the pre-eclamptic (236.4/mm3±8.3) compared to the non-pregnant group (322.0/mm3±10.4) (P=0.0001) s well as to the normal pregnant (275.0/mm3±8.9) (P = 0.003). In the pre-eclamptic cases, serum ALT correlated significantly with TWCC (r=0.26, P=0.03) and serum AST (r=0.65, P=0.000). In the pre-eclamptic cases, serum AST correlated significantly with Hb (r=0.26, P=0.03), serum ALT and serum uric acid (r=0.36, P=0.01).Conclusions: There was a considerable statistical significant decrease in mean platelets count of the pre-eclamptic compared to the non-pregnant group and to the normal pregnant may be explained by hemodilution; whereas further decrease was due to pre-eclampsia. ALT and AST are strong prognostic indicators of pre-eclampsia

Searching for VHE gamma-ray emission associated with IceCube neutrino alerts using FACT, H.E.S.S., MAGIC, and VERITAS

The realtime follow-up of neutrino events is a promising approach to searchfor astrophysical neutrino sources. It has so far provided compelling evidencefor a neutrino point source: the flaring gamma-ray blazar TXS 0506+056 observedin coincidence with the high-energy neutrino IceCube-170922A detected byIceCube. The detection of very-high-energy gamma rays (VHE, $\mathrm{E} >100\,\mathrm{GeV}$) from this source helped establish the coincidence andconstrained the modeling of the blazar emission at the time of the IceCubeevent. The four major imaging atmospheric Cherenkov telescope arrays (IACTs) -FACT, H.E.S.S., MAGIC, and VERITAS - operate an active follow-up program oftarget-of-opportunity observations of neutrino alerts sent by IceCube. Thisprogram has two main components. One are the observations of known gamma-raysources around which a cluster of candidate neutrino events has been identifiedby IceCube (Gamma-ray Follow-Up, GFU). Second one is the follow-up of singlehigh-energy neutrino candidate events of potential astrophysical origin such asIceCube-170922A. GFU has been recently upgraded by IceCube in collaborationwith the IACT groups. We present here recent results from the IACT follow-upprograms of IceCube neutrino alerts and a description of the upgraded IceCubeGFU system.<br

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Observation of the Gamma-Ray Binary HESS J0632+057 with the HESS, MAGIC, and VERITAS Telescopes

The results of gamma-ray observations of the binary system HESS J0632 + 057 collected during 450 hr over 15 yr, between 2004 and 2019, are presented. Data taken with the atmospheric Cherenkov telescopes H.E.S.S., MAGIC, and VERITAS at energies above 350 GeV were used together with observations at X-ray energies obtained with Swift-XRT, Chandra, XMM-Newton, NuSTAR, and Suzaku. Some of these observations were accompanied by measurements of the H alpha emission line. A significant detection of the modulation of the very high-energy gamma-ray fluxes with a period of 316.7 +/- 4.4 days is reported, consistent with the period of 317.3 +/- 0.7 days obtained with a refined analysis of X-ray data. The analysis of data from four orbital cycles with dense observational coverage reveals short-timescale variability, with flux-decay timescales of less than 20 days at very high energies. Flux variations observed over a timescale of several years indicate orbit-to-orbit variability. The analysis confirms the previously reported correlation of X-ray and gamma-ray emission from the system at very high significance, but cannot find any correlation of optical H alpha parameters with fluxes at X-ray or gamma-ray energies in simultaneous observations. The key finding is that the emission of HESS J0632 + 057 in the X-ray and gamma-ray energy bands is highly variable on different timescales. The ratio of gamma-ray to X-ray flux shows the equality or even dominance of the gamma-ray energy range. This wealth of new data is interpreted taking into account the insufficient knowledge of the ephemeris of the system, and discussed in the context of results reported on other gamma-ray binary systems

Observation of a sudden cessation of a very-high-energy gamma-ray flare in PKS 1510-089 with H.E.S.S. and MAGIC in May 2016

The flat spectrum radio quasar (FSRQ) PKS 1510-089 is known for its complex multiwavelength behavior, and is one of only a few FSRQs detected at very high energy (VHE, E >100 GeV) -rays. VHE -ray observations with H.E.S.S. and MAGIC during late May and early June 2016 resulted in the detection of an unprecedented flare, which reveals for the first time VHE -ray intranight variability in this source. While a common variability timescale of 1.5 hr is found, there is a significant deviation near the end of the flare with a timescale of ∼ 20 min marking the cessation of the event. The peak flux is nearly two orders of magnitude above the low-level emission. For the first time, curvature is detected in the VHE -ray spectrum of PKS 1510-089, which is fully explained through absorption by the extragalactic background light. Optical R-band observations with ATOM reveal a counterpart of the -ray flare, even though the detailed flux evolution differs from the VHE lightcurve. Interestingly, a steep flux decrease is observed at the same time as the cessation of the VHE flare. In the high energy (HE, E >100 MeV) -ray band only a moderate flux increase is observed with Fermi-LAT, while the HE -ray spectrum significantly hardens up to a photon index of 1.6. A search for broad-line region (BLR) absorption features in the -ray spectrum indicates that the emission region is located outside of the BLR. Radio VLBI observations reveal a fast moving knot interacting with a standing jet feature around the time of the flare. As the standing feature is located ∼ 50 pc from the black hole, the emission region of the flare may have been located at a significant distance from the black hole. If this correlation is indeed true, VHE rays have been produced far down the jet where turbulent plasma crosses a standing shock.Accepted manuscrip

Sensitivity of the Cherenkov Telescope Array for probing cosmology and fundamental physics with gamma-ray propagation

The Cherenkov Telescope Array (CTA), the new-generation ground-based observatory for γ astronomy, provides unique capabilities to address significant open questions in astrophysics, cosmology, and fundamental physics. We study some of the salient areas of γ cosmology that can be explored as part of the Key Science Projects of CTA, through simulated observations of active galactic nuclei (AGN) and of their relativistic jets. Observations of AGN with CTA will enable a measurement of γ absorption on the extragalactic background light with a statistical uncertainty below 15% up to a redshift z=2 and to constrain or detect γ halos up to intergalactic-magnetic-field strengths of at least 0.3 pG . Extragalactic observations with CTA also show promising potential to probe physics beyond the Standard Model. The best limits on Lorentz invariance violation from γ astronomy will be improved by a factor of at least two to three. CTA will also probe the parameter space in which axion-like particles could constitute a significant fraction, if not all, of dark matter. We conclude on the synergies between CTA and other upcoming facilities that will foster the growth of γ cosmology.</p

Broadband Multi-wavelength Properties of M87 during the 2017 Event Horizon Telescope Campaign

Abstract: In 2017, the Event Horizon Telescope (EHT) Collaboration succeeded in capturing the first direct image of the center of the M87 galaxy. The asymmetric ring morphology and size are consistent with theoretical expectations for a weakly accreting supermassive black hole of mass ∼6.5 × 109 M ⊙. The EHTC also partnered with several international facilities in space and on the ground, to arrange an extensive, quasi-simultaneous multi-wavelength campaign. This Letter presents the results and analysis of this campaign, as well as the multi-wavelength data as a legacy data repository. We captured M87 in a historically low state, and the core flux dominates over HST-1 at high energies, making it possible to combine core flux constraints with the more spatially precise very long baseline interferometry data. We present the most complete simultaneous multi-wavelength spectrum of the active nucleus to date, and discuss the complexity and caveats of combining data from different spatial scales into one broadband spectrum. We apply two heuristic, isotropic leptonic single-zone models to provide insight into the basic source properties, but conclude that a structured jet is necessary to explain M87’s spectrum. We can exclude that the simultaneous γ-ray emission is produced via inverse Compton emission in the same region producing the EHT mm-band emission, and further conclude that the γ-rays can only be produced in the inner jets (inward of HST-1) if there are strongly particle-dominated regions. Direct synchrotron emission from accelerated protons and secondaries cannot yet be excluded

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Correlations of complete blood count, liver enzyme and serum uric Acid in Sudanese pre-eclamptic cases

Background: Pre-eclampsia is a serious disorder of pregnancy with unknown ethological factors that may occur at any stage of second or third trimester of pregnancy. The objectives of the present study were to assess changes in complete blood counts including platelets, liver enzymes and serum uric acid in pre-eclamptic cases compared to second-half normal pregnant and non-pregnant Sudanese women and their correlations to other biomarkers.Methods: This was a cross-sectional, case-control study performed from December 2008 to December 2010; in Omdurman Maternity Hospital, in concomitance with other studies in pre-eclampsia. The sample size included three groups, 72 up pre-eclamptic cases in their recent pregnancies, 96 normal pregnant in their second half of pregnancy and 63 non- pregnant (control) women; a total of 231 subjects. Questionnaire Interviews and clinical examination were done for all participants. Laboratory investigations were done including complete blood picture, liver enzymes and uric acid.  Results: The mean Hb concentration of the pre-eclamptic (11.3g/dl±1.7) was statistically significantly lower than that of the non-pregnant (12.1g/dl±0.2) (P=0.01) but not from that of the normal pregnant (11.4g/dl±0.1) (P=0.882) .There was no statistical significant difference in the mean WBC count between the pre-eclamptic (7.4x103/mm3±0.3) and non-pregnant (7.3x103/mm3±0.3) (P=0.797) and between the pre-eclamptic and normal pregnant (7.7x103/mm3±0.2) (P=0.270). There was a considerable statistical significant decrease in the mean platelets count of the pre-eclamptic (236.4/mm3±8.3) compared to the non-pregnant group (322.0/mm3±10.4) (P=0.0001) s well as to the normal pregnant (275.0/mm3±8.9) (P = 0.003). In the pre-eclamptic cases, serum ALT correlated significantly with TWCC (r=0.26, P=0.03) and serum AST (r=0.65, P=0.000). In the pre-eclamptic cases, serum AST correlated significantly with Hb (r=0.26, P=0.03), serum ALT and serum uric acid (r=0.36, P=0.01).Conclusions: There was a considerable statistical significant decrease in mean platelets count of the pre-eclamptic compared to the non-pregnant group and to the normal pregnant may be explained by hemodilution; whereas further decrease was due to pre-eclampsia. ALT and AST are strong prognostic indicators of pre-eclampsia