Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients.

BACKGROUND: Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. METHODS: Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples. RESULTS: During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11-302.1, P = 0.04). CONCLUSIONS: MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients

Advice on assistance and protection from the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons : Part 2. On preventing and treating health effects from acute, prolonged, and repeated nerve agent exposure, and the identification of medical countermeasures able to reduce or eliminate the longer term health effects of nerve agents

The Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) has provided advice in relation to the Chemical Weapons Convention on assistance and protection. We present the SAB’s response to a request from the OPCW Director-General in 2014 for information on the best practices for preventing and treating the health effects from acute, prolonged, and repeated organophosphorus nerve agent (NA) exposure. The report summarises pre- and post-exposure treatments, and developments in decontaminants and adsorbing materials, that at the time of the advice, were available for NAs. The updated information provided could assist medics and emergency responders unfamiliar with treatment and decontamination options related to exposure to NAs. The SAB recommended that developments in research on medical countermeasures and decontaminants for NAs should be monitored by the OPCW, and used in assistance and protection training courses and workshops organised through its capacity building programmes.Peer reviewe

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

Pentingnya Memperkuat Eksistensi Pendidkan Islam Era ERA 4.0

Abstrak : Tujuan studi ini adalah untuk membuat orang lebih sadar akan kebutuhan mendesak untuk reformasi dalam pendidikan islam. Pendidikan Islam harus beradaptasi agar dapat memenuhi tuntutan dan harapan lingkungan global yang cepat berubah. Hal ini juga bertujuan untuk menciptakan komitmen yang jelas terhadap pendidikan islam mengingat revolusi industri keempat (Era 4.0) dan masalah yang dihadapinya. Sejak revolusi industri keempat (4.0) dimulai, hampir semua aspek kehidupan telah terkena dampaknya, termasuk pendidikan. Seperti yang kita tahu. Selama fenomena ini diganggu, komunitas pendidikan islam dituntut untuk menjadi bagian dari proses penyesuaian. Muslim yang baru lulus menghadapi tantangan baru, termasuk harapan dan peraturan yang belum pernah mereka hadapi sebelumnya. Mengikuti perkembangan zaman memerlukan peningkatan dan penemuan kembali segala sesuatu mulai dari proses dan tata kelola hingga kurikulum dan keterampilan sumber daya manusia hingga sarana dan prasarana. Pendidikan Islam, di sisi lain, akan semakin ketinggalan zaman. Karena itu, mengembangkan program pendidikan islam yang nyata sangat pentimg jika kita ingin tetap kompetitif di masa yang tidak pasti ini peserta harus menyela satu sama lain untuk mengerjakan solusi

Investigating the current environmental situation in the Middle East and North Africa (MENA) region during the third wave of COVID-19 pandemic : urban vs. rural context

Background Coronavirus 2019 (COVID-19) pandemic led to a massive global socio-economic tragedy that has impacted the ecosystem. This paper aims to contextualize urban and rural environmental situations during the COVID-19 pandemic in the Middle East and North Africa (MENA) Region. Results An online survey was conducted, 6770 participants were included in the final analysis, and 64% were females. The majority of the participants were urban citizens (74%). Over 50% of the urban residents significantly (p < 0.001) reported a reduction in noise, gathering in tourist areas, and gathering in malls and restaurants. Concerning the pollutants, most urban and rural areas have reported an increase in masks thrown in streets (69.49% vs. 73.22%, resp.; p = 0.003). Plastic bags and hospital waste also increased significantly with the same p-value of < 0.001 in urban areas compared with rural ones. The multifactorial logistic model for urban resident predictors achieved acceptable discrimination (AUROC = 0.633) according to age, crowdedness, noise and few pollutants. Conclusion The COVID-19 pandemic had a beneficial impact on the environment and at the same time, various challenges regarding plastic and medical wastes are rising which requires environmental interventions

Advice on assistance and protection provided by the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons: Part 3. On medical care and treatment of injuries from sulfur mustard

Blister agents damage the skin, eyes, mucous membranes and subcutaneous tissues. Other toxic effects may occur after absorption. The response of the Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) to a request from the OPCW Director-General in 2013 on the status of medical countermeasures and treatments to blister agents is updated through the incorporation of the latest information. The physical and toxicological properties of sulfur mustard and clinical effects and treatments are summarised. The information should assist medics and emergency responders who may be unfamiliar with the toxidrome of sulfur mustard and its treatment.Fil: Timperley, Christopher M.. Defence Science And Technology Laboratory; Reino UnidoFil: Forman, Jonathan E.. Organisation For The Prohibition Of Chemical Weapons; Países BajosFil: Abdollahi, Mohammad. Tehran University of Medical Sciences; IránFil: Al-Amri, Abdullah Saeed. Saudi Basic Industries Corporation; Arabia SauditaFil: Baulig, Augustin. Secrétariat Général de la Défense Et de la Sécurité Nationale; FranciaFil: Benachour, Djafer. Ferhat Abbas University; ArgeliaFil: Borrett, Veronica. La Trobe University; AustraliaFil: Cariño, Flerida A.. University Of The Philippines Diliman; FilipinasFil: Curty, Christophe. Spiez Laboratory; SuizaFil: Geist, Michael. Basf Se; AlemaniaFil: Gonzalez, David. Universidad de la República; UruguayFil: Kane, William. Monsanto Company; Estados UnidosFil: Kovarik, Zrinka. Institut Za Medicinska Istrazivanja I Medicinu Rada; CroaciaFil: Martínez Álvarez, Roberto. Universidad Complutense de Madrid; EspañaFil: Mourão, Nicia Maria Fusaro. Brazilian Chemical Industry; BrasilFil: Neffe, Slawomir. Wojskowa Akademia Techniczna; PoloniaFil: Raza, Syed K.. National Accreditation Board For Testing And Calibration Laboratories; IndiaFil: Rubaylo, Valentin. State Research Institute Of Organic Chemistry And Technology; RusiaFil: Suarez, Alejandra Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Química Rosario. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas. Instituto de Química Rosario; ArgentinaFil: Takeuchi, Koji. National Institute Of Advanced Industrial Science And Technology; JapónFil: Tang, Cheng. Ministry of National Defence. Office for the Disposal of Japanese Abandoned Chemical Weapons; ChinaFil: Trifirò, Ferruccio. Universidad de Bologna; ItaliaFil: Straten, Francois Mauritz van. Independent Former Opcw Sab Member; SudáfricaFil: Vanninen, Paula S.. University of Helsinki; FinlandiaFil: Vucinic, Slavica. Vojnomedicinska Akademija; SerbiaFil: Zaitsev, Volodymyr. Pontifícia Universidade Católica do Rio de Janeiro; BrasilFil: Zafar-Uz-Zaman, Muhammad. National Engineering And Scientific Commission; PakistánFil: Zina, Mongia Saïd. Université de Tunis El Manar, Faculté Des Sciences de Tunis; TúnezFil: Holen, Stian. OPCW; Países BajosFil: Alwan, Wesam S.. Monash University; AustraliaFil: Suri, Vivek. OPCW Office of Strategy and Policy; Países BajosFil: Hotchkiss, Peter J.. Organisation For The Prohibition Of Chemical Weapons; Países BajosFil: Ghanei, Mostafa. Baqiyatallah University Of Medical Sciences; Irá

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)