Impact of Age and Diastolic Function on Novel, 4D flow CMR Biomarkers of Left Ventricular Blood Flow Kinetic Energy

Two-dimensional (2D) methods of assessing mitral inflow velocities are pre-load dependent, limiting their reliability for evaluating diastolic function. Left ventricular (LV) blood flow kinetic energy (KE) derived from four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) may offer improvements. It remains unclear whether 4D LV blood flow KE parameters are associated with physiological factors, such as age when compared to 2D mitral inflow velocities. Fifty-three healthy volunteers underwent standard CMR, plus 4D flow acquisition. LV blood flow KE parameters demonstrated good reproducibility with mean coefficient of variation of 6 ± 2% and an accuracy of 99% with a precision of 97%. The LV blood flow KEiEDV E/A ratio demonstrated good association to the 2D mitral inflow E/A ratio (r = 0.77, P < 0.01), with both decreasing progressively with advancing age (P < 0.01). Furthermore, peak E-wave KEiEDV and A-wave KEiEDV displayed a stronger association to age than the corresponding 2D metrics, peak E-wave and A-wave velocity (r = −0.51 vs −0.17 and r = 0.65 vs 0.46). Peak E-wave KEiEDV decreases whilst peak A-wave KEiEDV increases with advancing age. This study presents values for various LV blood flow KE parameters in health, as well as demonstrating that they show stronger and independent correlations to age than standard diastolic metrics

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&nbsp;years; 78.2% included were male with a median age of 37&nbsp;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

The Spectrum of Glomerulonephritis in Saudi Arabia: The Results of the Saudi Registry

Only few studies regarding glomerulonephritis, with relatively small numbers of patients, have so far been published from different centers in Saudi Arabia, and have reported conflicting results regarding the patterns, even in the same city. The possible reasons for these differences include the small number of patients in the different studies, differences in the indications for renal biopsies, referral bias, geographical differences, and, sometimes, the non-availability of the necessary diagnostic facilities in the reporting centers. In order to overcome these problems, a registry for glomerulonephropathy was attempted in Saudi Arabia. Six large referral hospitals from different regions of Saudi Arabia participated in this registry. Biopsy reports and clinical information of 1294 renal biopsies were obtained. There were 782 renal biopsies due to glomerulonephritis (GN) accounting for 77.2&#x0025; of the total biopsies. Five hundred eighty seven <i> (72.6&#x0025;) </i> were primary glomerulonephritidis. Focal and segmental glomerulosclerosis (FSGS) (21.3&#x0025;) and membrano-proliferative glomerulonephritis (MPGN) (20.7&#x0025;) were the most common types found in the primary glomerulonephritidis. Membranous glomerulonephritis (MGN) was present in only 10.6&#x0025; of the cases. IgA nephropathy was found in <i> 6.5&#x0025; </i> of the cases. Of the secondary glomerulo-nephritides, systemic lupus erythematosus (SLE) was the most common indication for biopsy <i> (57.0&#x0025;) </i> and amyloidosis was found in only <i> 3.2&#x0025; </i> of the biopsies. In conclusion, FSGS and MPGN were the most common forms of primary glomerulonephritis in adult patients in Saudi Arabia. MGN was not as common as in the western world. SLE was the commonest cause of secondary GN. Amyloidosis was not as common as in other Arab countries. There is a need for more centers from Saudi Arabia to join this national GN registry. Similar registries can be established in different Arab countries, which all would, hopefully, lead to a Pan-Arab GN registry

Enriching Urea with Nitrogen Inhibitors Improves Growth, N Uptake and Seed Yield in Quinoa (Chenopodium quinoa Willd) Affecting Photochemical Efficiency and Nitrate Reductase Activity

Quinoa is a climate resilience potential crop for food security due to high nutritive value. However, crop variable response to nitrogen (N) use efficiency may lead to affect grain quality and yield. This study compared the performance of contrasting quinoa genotypes (UAF Q-7, EMS-line and JQH1) to fertilizer urea enriched with urease and nitrification inhibitors (NIs; 1% (w/w) thiourea + boric acid + sodium thiosulphate), ordinary urea and with no N as control. Application of NIs-enriched urea improved plant growth, N uptake and chlorophyll values in quinoa genotype UAF-Q7 and JHQ1, however, highest nitrate reductase (NR) activity was observed in EMS-line. Quinoa plants supplied with NIs-enriched urea also completed true and multiple leaf stage, bud formation, flowering, and maturity stages earlier than ordinary urea and control, nevertheless, all quinoa genotypes reached true and multiple leaf stage, flowering and maturity stages at same time. Among photosynthetic efficiency traits, application of NIs-enriched urea expressed highest photosynthetic active radiations (PAR), electron transport rate (ETR), current fluorescence (Ft) and reduced quantum yield (Y) in EMS line. Nitrogen treatments had no significant difference for panicle length, however, among genotypes, UAF-Q7 showed highest length of panicle followed by others. Among yield attributes, NIs-enriched urea expressed maximum 1000-seed weight and seed yield per plant in JQH-1 hybrid and EMS-line. Likely, an increase in quinoa grain protein contents was observed in JQH-1 hybrid for NIs-enriched urea. In conclusion, NIs-enriched urea with urease and nitrification inhibitors simultaneously can be used to improve the N uptake, seed yield and grain protein contents in quinoa, however, better crop response was attributed to enhanced plant growth and photosynthetic efficiency