Shear Strengthening of Prestressed Hollow Core Slabs using Externally Bonded Glass Fibre Reinforced Polymer Sheets

Precast prestressed hollow core (PHC) slabs are widely used as floor deck systems. However, as extrusion is the most widely adopted manufacturing technique of PHC slabs, it is difficult to arrange shear reinforcement during casting using an extrusion machine. Therefore, the shear capacity of a PHC slab relies on the shear strength of plain concrete, which makes them prone to shear failure near the support. Traditional solutions to increase the shear capacity of PHC slabs would add more weight and cost. Externally bonded fibre reinforced polymers (FRP) sheets have been successfully used over the past 20 years as an efficient technique for strengthening both the flexural and shear capacities of reinforced concrete members. During the first two phases of this research project, externally bonded carbon fibre reinforced polymers (CFRP) sheets along the internal perimeter of the PHC slab voids have proven to considerably increase the shear capacity of PHC slabs by up to 40%. The objective of the current research, which is Phase III, is to investigate and compare the effectiveness of glass fibres reinforced polymers (GFRP) sheets to CFRP sheets used in Phase I and Phase II to enhance the shear capacity of PHC slabs. A total of 11 full size PHC slabs, 1219 mm wide, 4500 mm long and 305 mm thick, were tested in Phase III. The effects of fibre type, the prestressing level, the width of the GFRP sheets, and the installation procedures for the shear capacity of PHC slabs were investigated. The ultimate strength, deflection, strands’ slippage, concrete strain and FRP strain were recorded, analyzed and compared to the results obtained in the previous study. The testing results show significant enhancement in the shear capacity and the behaviour of the PHC slabs strengthened by externally bonded GFRP sheets along the internal perimeter of the PHC slab voids comparable to the effect of the CFRP sheets

Emergency small- vs large-tube thoracostomy in chest trauma patients

Background: Therapeutic drainage is used to treat pleural disorders such as pneumothorax, hemothorax, empyema, chylothorax, and malignant effusions. This study aimed to conduct a comparative analysis of small (24-26 Fr) versus large (30-32 Fr) tube thoracostomy in terms of the efficacy of drainage due to concerns about obstruction (in the case of hemothorax) or inadequate drainage (in the case of hemothorax, pneumothorax, or hemopneumothorax), pain score, repositioning, and the need for thoracotomy. Methods: This randomized prospective study included 112 chest trauma patients who experienced significant hemothorax, pneumothorax, or a combination of these conditions in a trauma unit (reception, inpatient, or ICU) between December 2021 and December 2022. Patients were randomly divided into two groups. Group I included 56 patients who underwent small (24–26 Fr) tube thoracostomy and 56 patients in Group II, in which a large (30-32 Fr) tube thoracostomy was performed. We investigated the differences between the two groups in terms of pain score, complication rate, duration of tube insertion, and need for another chest tube or thoracotomy. Results: There was no statistically significant difference between the two groups concerning the mode of trauma, chest trauma, or effect of trauma (p= 0.781, 0.622, >0.99, and >0.99, respectively). The two groups had a highly statistically significant difference regarding the pain score (p<0.001). There was no statistically significant difference between the two groups regarding the duration of tube insertion (P<0.001). There were no statistically significant differences between the two groups regarding outcomes (drainage efficacy, tube repositioning, tube replacement, or the need for thoracotomy) (p= 0.315, 0.344, and 0.814, respectively). Conclusion: Increasing the tube size might not affect the efficacy of drainage, the duration of tube insertion, the need for another tube, or the need for thoracotomy. Small (24-26 Fr) tube thoracostomies could also have favorable pain score outcomes

Non-Invasive Panel for Prediction of Large Esophageal Varices in Patients with HCV-Related Cirrhosis after DAAS Therapy

To study sonographic and laboratory parameters as diagnostic non-invasive Indices for prediction and screening of large varices in liver cirrhotic patients post hepatitis C virus after direct Actin antiviral drugs (DAAS). Introduction: All cirrhotic patients should be screened for esophageal varices (EV) via endoscopy, as recommended by the guidelines. However, repeated endoscopy is not well accepted by patients and is a costly procedure that places a heavy burden on the endoscopic unit. Therefore, noninvasive predictors of EVs and size discrimination for EVs are of particular importance.After dividing DAAS into three arms: arm 1 with Non-EV, arm 2grad1&2 EV (Small Vriceal arm), and arm 3 grade 3&4 EV (Large Variceal arm). medical history, physical examination, standard laboratory tests, abdominal ultrasound, and sonographic parameters such as portal vein velocity (PVV). Splenic Index (SI) Splenoportal Index (SPI), platelet count/spleen diameter ratio (PCSDR) and upper gastrointestinal endoscopy were performed for all participants.Results: The Noninvasive sonographic and laboratory parameters for prediction of the presence of EVs have demonstrated that low platelet count/spleen diameter ratio (PC/SD) at cut-off (CO) ≤ 1121.43 cu/mm, then high SPI at CO >3.98 cm /sec then high FIB4 at CO > 2.68 then high APRI at CO > 0.6 then PVV at CO ≤ 22.2 cm/sec then high SI at CO > 89.7 and lastly Child’s – Pugh’s score at CO > 6 respectively.. The Non Invasive sonographic and laboratory parameters for discrimination of the size of EVs showed that high SPI was found to be the most accurate parameter at CO less than >7.75 cm/sec Then low PC/SD at CO ≤ 514.08 cu/mm then high APRI at CO > 1.4 then high FIB4 at CO > 7,6 then high SI with AUC 0.821 at CO > 122.4 then low PVV at CO < 15 and lastly Child’s –Pugh’s score at CO> 6 respectively.Conclusions: The sonographic and laboratory indices are non- invasive parameters for the prediction of EV & discrimination of its size. And to determine when Upper Endoscopy is done for liver cirrhotic patients post-C after DAA

Treatment of Sweet Pepper with Stress Tolerance-Inducing Compounds Alleviates Salinity Stress Oxidative Damage by Mediating the Physio-Biochemical Activities and Antioxidant Systems

Salinity stress occurs due to the accumulation of high levels of salts in soil, which ultimately leads to the impairment of plant growth and crop loss. Stress tolerance-inducing compounds have a remarkable ability to improve growth and minimize the effects of salinity stress without negatively affecting the environment by controlling the physiological and molecular activities in plants. Two pot experiments were carried out in 2017 and 2018 to study the influence of salicylic acid (1 mM), yeast extract (6 g L−1), and proline (10 mM) on the physiological and biochemical parameters of sweet pepper plants under saline conditions (2000 and 4000 ppm). The results showed that salt stress led to decreasing the chlorophyll content, relative water content, and fruit yields, whereas electrolyte leakage, malondialdehyde (MDA), proline concentration, reactive oxygen species (ROS), and the activities of antioxidant enzymes increased in salt-stressed plants. The application of salicylic acid (1 mM), yeast extract (6 g L−1), and proline (10 mM) markedly improved the physiological characteristics and fruit yields of salt-stressed plants compared with untreated stressed plants. A significant reduction in electrolyte leakage, MDA, and ROS was also recorded for all treatments. In conclusion, our results reveal the important role of proline, SA, and yeast extracts in enhancing sweet pepper growth and tolerance to salinity stress via modulation of the physiological parameters and antioxidants machinery. Interestingly, proline proved to be the best treatment.</jats:p

Metal-Bound Methisazone; Novel Drugs Targeting Prophylaxis and Treatment of SARS-CoV-2, a Molecular Docking Study.

SARS-CoV-2 currently lacks effective first-line drug treatment. We present promising data from in silico docking studies of new Methisazone compounds (modified with calcium, Ca; iron, Fe; magnesium, Mg; manganese, Mn; or zinc, Zn) designed to bind more strongly to key proteins involved in replication of SARS-CoV-2. In this in silico molecular docking study, we investigated the inhibiting role of Methisazone and the modified drugs against SARS-CoV-2 proteins: ribonucleic acid (RNA)-dependent RNA polymerase (RdRp), spike protein, papain-like protease (PlPr), and main protease (MPro). We found that the highest binding interactions were found with the spike protein (6VYB), with the highest overall binding being observed with Mn-bound Methisazone at -8.3 kcal/mol, followed by Zn and Ca at -8.0 kcal/mol, and Fe and Mg at -7.9 kcal/mol. We also found that the metal-modified Methisazone had higher affinity for PlPr and MPro. In addition, we identified multiple binding pockets that could be singly or multiply occupied on all proteins tested. The best binding energy was with Mn-Methisazone versus spike protein, and the largest cumulative increases in binding energies were found with PlPr. We suggest that further studies are warranted to identify whether these compounds may be effective for treatment and/or prophylaxis

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Role of fluoroscopic guided self expandable metallic stents in the management of malignant esophageal strictures

Objectives: To evaluate the role of fluoroscopic guided self expanding metallic stents in the management of dysphagia caused by malignant esophageal strictures. Materials and methods: During the period between April 2010 and October 2012, 31 patients with malignant esophageal strictures were subjected to fluoroscopic guided self expanding metallic stent application. The study included 22 males and 9 females ranging in age between 22 and 75 years old with mean age of 56.8 years. Lesions were located in the lower esophagus and gastroesophageal junction in 22 patients and middle esophagus in 9 patients. Results: Technical success was achieved in all 31 cases (100%). The clinical success was 96.7% with 81% mean improvement in dysphagia according to dysphagia score. Only one major complication occured (3.2%) which was proximal stent migration. Conclusion: Fluoroscopic guided esophageal stenting is a highly effective and safe method for palliating dysphagia in patients with obstructing esophageal cancer with significant clinical improvement