Clinical Staging and Flowcytomteric CD38 and Zap 70 Prognostic Indicators in Sudanese Patients with Chronic Lymphocytic Leukemia

Background: The clinical course of chronic lymphocytic leukemia is highly variable. The determination of ZAP70 and CD38 is increasingly utilized as prognostic factor for chronic lymphocytic leukemia. The aim of conducting this study was to investigate the frequency of CD38 and ZAP70 expression among Sudanese Chronic lymphocytic leukemia (CLL) patients and to relate them to the Binet and Rai clinical staging systems. Method: A total of 93 patients (mean age; 62.29 ± 11.68, sd) were enrolled in this cross-sectional study. CD38 and ZAP70 expression levels were measured with four color flowcytometry using the cut-off values of 20% for ZAP70 and 30% for CD38 expression. Staging was assessed by using clinical examination and CBC for all patients. Data were analyzed using the Statistical Package for Social science for Windows (SPSS), version 22. Results: There were 93 CLL patients and the median age of the group was 63 years (36–95 years). About 71% of the patients presented with lymphadenopathy, 53.8% with splenomegaly, 73.1% with anemia, and 45.2% with thrombocytopenia. There was higher frequency of Binet stage C and Rai stage IV (62 [66.6%] patients and 34 [36.5%] patients, respectively). In addition, CD38 and ZAP70 showed higher frequency among Binet and Rai advance stages. ZAP70 and CD38 positivity were detected in 21 patients (22.6%) and 31 patients (33.3%), respectively. There was no statistically significant association between ZAP70 and CD38 and clinical staging systems (P-value > 0.05). Conclusion: No significant association was observed between Flowcytometric (CD38 and Zap70) Prognostic Indicators and clinical staging systems. Keywords: chronic lymphocytic Leukemia, Flowcytometry, ZAP70, CD38, clinical staging system

Observations of changes in acoustic emission parameters for varying corrosion defect in reciprocating compressor valves

Acoustic Emission (AE) technology is probably one of the most recent entries in the field of machinery condition monitoring. This paper investigates the application of AE parameters for valve faults detection in reciprocating compressor. The defective valves were designed by emulating the actual valve corrosion with varying sizes such that defects could be applied onto the reciprocating compressor. A set of experiments was performed to acquire the AE signal. The primary source of AE signal was verified using waveform analysis. The AE parameters versus different operational and valve condition were illustrated individually. In addition, the significance of the change and sensitivity of AE parameters versus different experimental conditions was verified using MANOVA and coefficient of variance analysis. It is concluded that the AE signal parameters can be used to detect the valve faults in the reciprocating compressor with the consideration of the variation in the AE parameters sensitivity

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

Knowledge and attitudes toward COVID-19 vaccination in Sudan: A cross-sectional study

Background: Vaccines are an essential part of public health interventions to mitigate the devastating health and non-health impacts of COVID-19 pandemic. Despite the fact that Sudan launched the COVID-19 vaccination program in March 2021, only 10% of the population received their two primary doses of vaccines by the end of May 2022. This delayed uptake of vaccines obviously warrants investigation. Therefore, we have conducted this study to evaluate the knowledge, attitude and acceptance of the general population in Sudan toward COVID-19 vaccines. Methodology: A descriptive cross-sectional community-based study. The data were collected using an electronic questionnaire from 403 individuals living in Khartoum, Sudan. The data were processed using the Statistical Package for Social Sciences (SPSS), and data analysis was performed using appropriate tests. Results: 51% of the participants were found to have sufficient knowledge about the COVID-19 vaccine, and the knowledge level is higher among those educated beyond the secondary school and those who were employed. Among those unvaccinated, only 47% of the participants expressed their intention to take the vaccine when offered to them. The major reason for not trusting the vaccine is safety concerns expressed by 65.5% of the unvaccinated. Conclusion: Higher education levels and employment were associated with an increase in sufficient knowledge about the vaccine in around half of the participants. However, most of participants had not taken the vaccine at the time of the study, and the trust in vaccines is not high. Effective interventions by the health authorities are needed to address these issues in order to accelerate the COVID-19 vaccination program in Sudan

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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

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 < 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

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

A fuzzy logic approach for selecting bearing ring materials in pharmaceutical applications

The present market trend of prioritizing safety and dependability at competitive rates has prompted the pharmaceutical and medical sectors to search more biocompatible, sustainable, and safe supplies. This paper seeks to achieve the most demanding criteria for pharmaceutical product safety, production capabilities, and performance standards. Hence, in order to avoid contamination, these sectors have set strict controls on the materials used in the manufacture of pharmaceutical and medical equipment. The purpose of this work is to introduce the FAHP-FTOPSIS technique, which offers an innovative and systematic way to selecting pharmaceutical bearing materials, filling research gaps, and enhancing pharmaceutical equipment design. The crucial issue of selecting appropriate bearing ring materials for pharmaceutical applications is addressed in this work. This research suggests the use of fuzzy logic as an innovative and successful technique to addressing this issue. Fuzzy logic is used to handle and evaluate linguistic data linked with the performance criteria of various materials such as PEEK, PTFE, Acetal, Stainless Steel, and Nylon6. A preference-based approach was used to conduct a comprehensive analysis of five commonly used materials for bearing rings. This included a direct comparison of different polymers, which are gaining favor in the pharmaceutical device sector, and stainless steel, that have traditionally been used for pharmaceutical equipment. The assessment was performed using the FAHP (Fuzzy Analytical Hierarchy Process), which assigned performance weight criteria as follows: C1 (0.128, 0.153, 0.139), C2 (0.082, 0.041, 0.019), C3 (0.425, 0.107, 0.371), C4 (0.528, 0.215, 0.089), C5 (0.137, 0.072, 0.036), C6 (0.092, 0.153, 0.172), C7 (0.063, 0.049, 0.032), C8 (0.048, 0.25, 0.049), and so on. Then, the FTOPSIS (Fuzzy Technique for Order of Preference by Similarity to Ideal Solution) was used to rank the alternatives, with the following results revealing the order: PEEK > Acetal > Nylon 6 > Stainless Steel > PTFE. This novel technology has the potential to improve the precision of material selection, therefore enhancing the overall efficiency and safety of pharmaceutical equipment and processes. The results clearly indicate that PTFE-based bearings surpass metallic ones in several aspects, including corrosion resistance, quiet operation, and minimal routine maintenance requirements. Remarkably, the calculated weight criteria align closely with the manufacturer's provided data. This innovative hybrid approach, combining FAHP (Fuzzy Analytical Hierarchy Process) and FTOPSIS (Fuzzy Technique for Order of Preference by Similarity to Ideal Solution), has the potential to simplify and optimize new product designs for pharmaceutical devices, reducing costs in the process. These findings highlight the efficacy of the FAHP-FTOPSIS technique in addressing the hitherto unexplored challenge of selecting suitable bearing component materials for specific applications. This approach offers a promising avenue for enhancing pharmaceutical device performance and reliability, marking a significant advancement in this field

Numerical investigations on axial and radial blade rubs in turbo-machinery

© Published under licence by IOP Publishing Ltd. In the recent years, the clearance between the rotor blades and stator/casing had been getting smaller and smaller prior improving the aerodynamic efficiency of the turbomachines as demand in the engineering field. Due to the clearance reduction between the blade tip and the rotor casing and between rotor blades and stator blades, axial and radial blade rubbing could be occurred, especially at high speed resulting into complex nonlinear vibrations. The primary aim of this study is to address the blade axial rubbing phenomenon using numerical analysis of rotor system. A comparison between rubbing caused impacts of axial and radial blade rubbing and rubbing forces are also aims of this study. Tow rotor models (rotor-stator and rotor casing models) has been designed and sketched using SOILDSWORKS software. ANSYS software has been used for the simulation and the numerical analysis. The rubbing conditions were simulated at speed range of 1000rpm, 1500rpm and 2000rpm. Analysis results for axial blade rubbing showed the appearance of blade passing frequency and its multiple frequencies (lx, 2x 3x etc.) and these frequencies will more excited with increasing the rotational speed. Also, it has been observed that when the rotating speed increased, the rubbing force and the harmonics frequencies in x, y and z-direction become higher and severe. The comparison study showed that axial blade rub is more dangerous and would generate a higher vibration impacts and higher blade rubbing force than radial blade rub