The senses perceive the meanings of graphic processors on smartphones

Perception is a processing of information that comes from the senses to the brain, so that the complex central nervous system determines, organizes and interprets information to understand the world around us, and one of the most important senses is the sense of sight, which includes external visual vision, mental vision, imaginative and internal emotional, through which the human mind adds The meaning depends on the sensory perceptions that it receives, whatever they are. When you see a shape, the eye keeps searching for the meaning of its parts. Visual perception is the ability to interpret the surrounding environment, by interpreting information within visible light. Aesthetic perception is a process of mental activity that takes place after receiving signals emitted from graphics. Through the senses, which is the ability to feel the artwork, whether plastic works or videos loaded on mobile phones, which have become apparent to a large segment of society in displaying and watching artworks through mobile phones, which are affected by various factors on which the perception of the senses of the recipient who enjoys a prior visual culture depends. For artistic work as a result of the stability of the formal perceptions of the work of art.The research problemWhat are the factors that affect the perception of the meanings of the mobile graphic processors on smart phones?Is the process of sensory perception of the meanings of motion graphics affected on smartphones?The research aims:Determine the perception factors that are affected by mobile graphics processors on smartphones.Emphasis on the aspects of the process of perception of the senses of the meanings of the animated graphics on smartphonesresearch importance:Standing on the modern capabilities of smartphones in running animated graphics.Emphasizing of the complementarity of the senses in perceiving the animation graphics in smartphones

Role of Prostaglandin E2 in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Background: Spontaneous bacterial peritonitis (SBP) is the most frequent bacterial infection in patients who suffer from liver cirrhosis and ascites. Prostaglandin E2 (PGDE2) is considered a simple and accurate tool for diagnosing systemic inflammation and has a relevant impact on prognosis in cirrhotic patients.Objective: We tried to detect the role of PGDE2 in serum and ascitic fluid as a diagnostic marker for eradication of SBP.Patients and methods: This clinical-based prospective cohort study involved patients with liver cirrhosis, ascites and spontaneous bacterial peritonitis referred to the Internal Medicine Department, Faculty of Medicine, Zagazig University during the period from June 2020 to March2021. Patients with ascites were divided equally into: (a) case group included cirrhotic patients with SBP); and (b) control group included cirrhotic patients without SBP. All patients were subjected to complete clinical and laboratory examination. Serum and ascitic PGDE2 were estimated before and after five days of treatment. Results: There was statistically significant difference between the studied groups regarding Child score and presence of HCC. Serum and ascitic PGDE2 was elevated in all cirrhotic groups; both of case and control had more than normal. However, PGDE2 level was lower in case group before treatment in comparison with control group, and after treatment PGDE2 levels was elevated.Conclusion: Serum and ascitic fluid PGDE2 can be used as a diagnostic marker for SBP diagnosis and eradication. Serum PGDE2 is preferred due to its less invasiveness and minimal risk of complications

Serum Soluble CD93 as a Biomarker of Asthma Exacerbation in Children

Background: Asthma is considered one of the most prevalent diseases affecting over than 300 million individuals worldwide. Soluble CD93 was normally detected in human plasma and induced by the inflammatory mediators TNF-α and LPS, suggesting that physiologic pathways trigger the cleavage event. Objective: To evaluate the diagnostic value of serum soluble CD93 level in acute asthma exacerbation in children and to find if there is a relation between serum level of soluble CD93 and acute exacerbations of asthma among children. Patients and Methods: Our study included 30 patients who were diagnosed as acute asthmatics with acute exacerbation (diagnosed and classified according to GINA 2018) as group I. Group Π, which included the same 30 patients after receiving treatment and relieve of symptoms by clinical examination as well as routine laboratory investigations that confirmed their healthy state. Plasma sCD93 concentration using ELISA (at the time of exacerbation and repeated on the follow up day) and spirometry were done. Results: Regarding severity (after classification of cases into intermittent, mild and moderate), there was no statistical significance difference in severity either pre- or post-treatment. Regarding sCD93, there was statistical significance reduction in sCD 93 level post-treatment compared to pre-treatment in all cases. There were no statistical significance relation between gender, residence and family history and sCD 93 levels among the studied group. There were no statistical significance relation between WBCs and x-ray and sCD 93 levels among the studied group. Conclusion: sCD93 was not affected by gender or age and did not affect by reliever or controller medications. sCD93 showed a modest decrease in the controlled stage of asthma, which allowed to interpret its role as inflammatory biomarker

Effect of intensive phototherapy on T and B lymphocyte function in neonatal jaundice

Background: Jaundice is one of the most common problems that affect newborns in the first few days of life. Approximately 60% of full-term and 80% of the preterm newborn may develop neonatal jaundice. Although neonatal jaundice is of physiological type in most of these cases, some cases may have elevated serum bilirubin levels which, if not treated, may lead to bilirubin encephalopathy and subsequently bilirubin induced neurological dysfunction (BIND). Objective: This study aimed to evaluate the effect of intensive phototherapy on B and T cells by measuring the percentages of CD19+, CD4+ and CD8+ lymphocytes subsets in newborns after 72 hours from exposure to intensive phototherapy to evaluate its effect on the immune system.Patients and methods: A prospective cohort study carried out in Zagazig University Hospital, Pediatric Neonatal Intensive Care Unit (NICU) and Clinical Pathology Departments. The study included 50 full-term newborns. Results: There was no significant difference regarding CD4, CD8 and CD19 for the patient group. Furthermore, the study showed that the percentages of CD4+ and CD8+ lymphocytes subsets showed no change in newborns after 72 hours of exposure to phototherapy, but CD19+ was highly significantly lower before treatment only. In addition, the follow up of those 25 jaundiced newborns for occurrence and frequency of infection and need for hospitalization for a period of six months after discharge showed no effect.Conclusion: our results showed no effect of phototherapy on lymphocyte subsets after 72 hours of exposure and no effect on infant immunity

Assessment of level of serum cardiac troponin T in neonates with respiratory distress syndrome

Background: One of the most prevalent reasons for admission to neonatal intensive care units (NICUs) is respiratory distress syndrome (RDs). When myocardial cells are damaged, cardiac troponin I (cTnT) is released as a biomarker of myocardial damage, which is very specific and sensitive.Objective: To determine the level of cTnT in preterm infants who have respiratory distress syndrome as a marker of cardiac dysfunction.Patients and Methods: This study was carried as a case-control trial on forty preterm infants, 20 patients of respiratory distress syndrome at neonatal intensive care unit as a group I, 20 apparently healthy newborns as a control group. Serum cardiac troponin T level sample was taken on the 3rd day of delivery.Results: A statistically significant difference in blood troponin was found between the groups tested, with a negative connection between serum troponin and gestational age, length, and APGAR scores at the first and fifth minutes of life. Respiratory rate and serum troponin were found to have a statistically significant connection. Any one of the echocardiographic measures had a statistically significant positive connection with serum troponin. Serum troponin was able to diagnose respiratory distress syndrome with cutoff ≥ 93.5 ng/mL with the area under the curve, Positive predictive value: 83.33% Positive predictive value: 83.33% Negative predictive value: 100 percent Accuracy: 90%.Conclusion: Cardiac troponin T can be used to detect cardiac dysfunction in ill newborns, especially in centers that do not have in-house echocardiography

Case Report: Autochthonous Case of Human Visceral Leishmaniasis in the West Bank, Palestine

Human visceral leishmaniasis (HVL) is a parasitic disease infecting children in the Mediterranean region. Here,weportray a case of a 2-year-old child with an epidemiological description of the situation surrounding the case. The patient was suffering from recurrent fever, weakness and abdominal discomfort associated with loss of appetite. Routine blood investigations showed pancytopenia, whereas examination revealed hepatomegaly. A diagnosis of HVL was made by demonstrating amastigotes in a Giemsa-stained smear from a bone marrow aspirate followed by genotyping by PCR and sequencing. In conclusion, early detection of VL infection followed by appropriate treatment protocols is essential to saving the patient

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

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030