Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

BACKGROUND: The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure. CLINICAL CASE: A simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma. DIAGNOSIS: Postoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease. TREATMENT: We successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients

GridCell: a stochastic particle-based biological system simulator

<p>Abstract</p> <p>Background</p> <p>Realistic biochemical simulators aim to improve our understanding of many biological processes that would be otherwise very difficult to monitor in experimental studies. Increasingly accurate simulators may provide insights into the regulation of biological processes due to stochastic or spatial effects.</p> <p>Results</p> <p>We have developed GridCell as a three-dimensional simulation environment for investigating the behaviour of biochemical networks under a variety of spatial influences including crowding, recruitment and localization. GridCell enables the tracking and characterization of individual particles, leading to insights on the behaviour of low copy number molecules participating in signaling networks. The simulation space is divided into a discrete 3D grid that provides ideal support for particle collisions without distance calculation and particle search. SBML support enables existing networks to be simulated and visualized. The user interface provides intuitive navigation that facilitates insights into species behaviour across spatial and temporal dimensions. We demonstrate the effect of crowing on a Michaelis-Menten system.</p> <p>Conclusion</p> <p>GridCell is an effective stochastic particle simulator designed to track the progress of individual particles in a three-dimensional space in which spatial influences such as crowding, co-localization and recruitment may be investigated.</p

VN-Transformer: Rotation-Equivariant Attention for Vector Neurons

Rotation equivariance is a desirable property in many practical applications such as motion forecasting and 3D perception, where it can offer benefits like sample efficiency, better generalization, and robustness to input perturbations. Vector Neurons (VN) is a recently developed framework offering a simple yet effective approach for deriving rotation-equivariant analogs of standard machine learning operations by extending one-dimensional scalar neurons to three-dimensional "vector neurons." We introduce a novel "VN-Transformer" architecture to address several shortcomings of the current VN models. Our contributions are: $(i)$ we derive a rotation-equivariant attention mechanism which eliminates the need for the heavy feature preprocessing required by the original Vector Neurons models; $(ii)$ we extend the VN framework to support non-spatial attributes, expanding the applicability of these models to real-world datasets; $(iii)$ we derive a rotation-equivariant mechanism for multi-scale reduction of point-cloud resolution, greatly speeding up inference and training; $(iv)$ we show that small tradeoffs in equivariance ($\epsilon$-approximate equivariance) can be used to obtain large improvements in numerical stability and training robustness on accelerated hardware, and we bound the propagation of equivariance violations in our models. Finally, we apply our VN-Transformer to 3D shape classification and motion forecasting with compelling results.Comment: Published in Transactions on Machine Learning Research (TMLR), 2023; Previous version appeared in Workshop on Machine Learning for Autonomous Driving, Conference on Neural Information Processing Systems (NeurIPS), 202

Determinants of College and University Choice for High-School Students in Qatar

Drawing on existing research, this paper investigates various predictors of high school students’ college and university choice decisions in Qatar. Based on a 2015 survey of 1,427 participants, this study utilized exploratory factor analysis to identify variables that affect student choice of higher educational institutions (HEI). Three factors were extracted from the analysis, revealing the following aspects of the academic experience as important when choosing a HEI: quality of education, cultural values, and the cost of education. To further the understanding of the relevance of these factors for different student demographics, we employed ordinal logistic regression to test whether several independent variables (student’s gender, nationality, parental education, and parental occupation) act as significant predictors of the three extracted dimensions (dependent variables). The analysis revealed that, indeed, demographic characteristics significantly predict, to varying degrees, all three factors affecting student’s HEI choice. Discussion on postulated reasons behind the recorded relationships will follow, along with implications and recommendations for further study and research. Findings of this study will help HEIs in Qatar and the broader region to position themselves more effectively, and develop targeted strategies that attract a diverse student population

Barriers to the delivery of diabetes care in the Middle East and South Africa: a survey of 1,082 practising physicians in five countries

SUMMARY Aims: Developing countries face a high and growing burden of type 2 diabetes. We surveyed physicians in a diverse range of countries in the Middle East and Africa (Egypt, Kingdom of Saudi Arabia, United Arab Emirates, South Africa and Lebanon) with regard to their perceptions of barriers to type 2 diabetes care identified as potentially important in the literature and by the authors. Methods: One thousand and eighty-two physicians completed a questionnaire developed by the authors. Results: Most physicians enroled in the study employed guideline-driven care; 80–100% of physicians prescribed metformin (with lifestyle intervention, where there are no contraindications) for newly diagnosed type 2 diabetes, with lifestyle intervention alone used where metformin was not prescribed. Sulfonylureas were prescribed widely, consistent with the poor economic status of many patients. About one quarter of physicians were not undertaking any form of continuing medical education, and relatively low proportions of practices had their own diabetes educators, dieticians or diabetic foot specialists. Physicians identified the deficiencies of their patients (unhealthy lifestyles, lack of education and poor diet) as the most important barriers to optimal diabetes care. Low-treatment compliance was not ranked highly. Access to physicians did not appear to be a problem, as most patients were seen multiple times per year. Conclusions: Physicians in the Middle East and South Africa identified limitations relating to their patients as the main barrier to delivering care for diabetes, without giving high priority to issues relating to processes of care delivery. Further study would be needed to ascertain whether these findings reflect an unduly physician-centred view of their practice. More effective provision of services relating to the prevention of complications and improved lifestyles may be needed. What's known It is known that the success of care for diabetes depends critically on the delivery of optimised care for diabetic patients. Many barriers to the delivery of such care have been identified. Relatively little is known regarding how these barriers influence the delivery of diabetes care in the Middle East and South Africa. What's new Physicians generally followed management guidelines in type 2 diabetes care. Perceived barriers to optimal diabetes care mainly focussed on attributes of patients, rather than process issues in care or aspects of the physicians' practice

Study of the effect of HFE gene mutations on iron overload in Egyptian thalassemia patients

Background: HFE gene mutations have been shown to be responsible for hereditaryhemochromatosis. Their effect on iron load in β-thalassemia patients and carriers remains controversial.Objectives: We aimed to determine the prevalence of HFE gene mutations (C282Y and H63D) in β-thalassemia patients and carriers and to investigate its effect on their serum ferritin levels.Patients and methods: A total of 100 β-thalassemia subjects; 75 patients and 25 carriers were screened for HFE gene mutations by PCR-RFLP. Serum ferritin measured by ELISA was evaluated in relation to HFE mutations.Results: Twenty-eight β-thalassemia patients (37.3%) were heterozygotes for H63D mutation (H/D), 8 (10.7%) were D/D and 39 (52%) were negative (H/H). Among carriers, 4 (16%) were D/D and 21 (84%) were H/H homozygotes. C282Y mutant allele was not detected in any of the subjects. Serum ferritin levels were significantly higher in β-thalassemia patients heterozygotes or homozygotes for H63D mutation compared to those without mutation (p= 0.000). Carriers homozygotes for H63D mutation showed significantly higher serum ferritin levels compared to those without mutation (p&lt; 0.001).Conclusion: Homozygosity for H63D mutation tends to be associated with higher ferritin levels in beta-thalassemia patients and carriers suggesting its modulating effect on iron load in these cases

Building social policies in Lebanon

Texte en français, en anglais et en arab

Building social policies in Lebanon

Texte en français, en anglais et en arab

Prediabetes management in the Middle East, Africa and Russia: Current status and call for action:

Most data on the burden of diabetes and prediabetes are from countries where local infrastructure can support reliable estimates of the burden of non-communicable diseases. Countries in the Middle ..