Pulmonary hydatid cyst in pregnancy

A 26-year-old pregnant lady was referred from a private hospital to the emergency department with a cough, shortness of breath, decreased oxygen saturation, and repeated vomiting. She went to the private hospital for obstetrics and gynecology follow-up for her pregnancy. The patient is 21 weeks pregnant with no known comorbidities. She is gravida three and para two. The patient claimed that since 3 days, the shortness of breath (SOB) and cough have been worsening, and she has been inducing herself to vomit more frequently, however, there is no associated dysphagia. She denied fever, headache, dizziness, abdominal pain, or a change in bowel habits

Assessment of vehicular live load and load factors for design of short-span bridges according to the new Egyptian Code

AbstractThe new Egyptian Code (ECP-201:2012) introduces new vehicular live loads (VLL) and new load combinations for the design of roadway bridges. The new VLL and load combinations introduced in ECP-201:2012 are fundamentally different than those presented in previous versions of the code. The impact of these new loads and load combinations on the design of new bridges or the structural safety of the existing bridges that have been designed according to ECP-201:2003 or ECP-201:1993 has not been fully addressed for the different bridge deck systems. Three different bridge deck systems, i.e. concrete I-shaped girders, composite steel plate girders, and concrete box-girders with different spans were numerically modeled using two-dimensional grillage analogy. The bridge decks were analyzed under main gravity loads using VLL according to ECP-201:2012 and ECP-201:2003. The internal forces of individual load cases, total un-factored load combination, and total factored load combination of ECP-201:2012 and ECP-201:2003 were compared.The study shows that concrete box-girders designed according to ECP-201:2012 and ECP-201:2003 using the ultimate limit state method yield almost the same demand. Despite the increase in the VLL of ECP-201:2012, and consequently the live load forces, concrete I-shaped girder bridges will be subjected to less total factored internal forces in comparison to ECP-201:2003 This is attributed to the interaction between the live to dead loads ratio and the load combinations. Design of composite steel plate girder bridges according to ECP-201:2012 using the allowable stress design method yields over designed sections

Factors Affecting Patients’ Use of Electronic Personal Health Records

England has recently introduced a nationwide electronic personal health record (ePHR) called Patient Online. Although ePHRs are widely available, adoption rates of ePHRs are usually low. Understanding the factors affecting patients’ use of ePHRs is considered important to increase adoption rates and improve the implementation success of ePHRs. Therefore, the current study aims to examine the factors that affect patients’ adoption of ePHRs in England. A systematic review was conducted to identify factors that affect patients’ adoption of ePHRs. Then, the most common theories and models relevant to technology adoption and human behaviour were reviewed to select an appropriate theory and use it as a theoretical lens for examining the factors in the current study. The Unified Theory of Acceptance and Use of Technology (UTAUT) was selected and tailored to the context of ePHRs by including the most influential factors identified by the systematic review. A cross-sectional survey of 624 patients in four general practices in West Yorkshire was carried out to empirically examine the proposed model via structural equation modelling. The results showed that performance expectancy, effort expectancy, and perceived privacy and security were significant predictors of behavioural intention. The relationship between social influence and behavioural intention was not statistically significant. Both facilitating conditions and behavioural intention affected use behaviour. Performance expectancy was also a significant mediator of the effect of both effort expectancy and perceived privacy and security on behavioural intention. Eleven relationships were moderated by age, sex, income, education, ethnicity, and internet access. The proposed model accounted for 76% and 48% of the variance in behavioural intention and use behaviour, respectively. The current study makes a significant contribution by adapting and validating a theoretical model (UTAUT) in a new context (ePHRs). Further, this study contributes to practices by providing several implications for developers, marketers, and GP practices

Deleterious effects of polypropylene released from paper cups on blood profile and liver tissue of Clarias gariepinus: bioremediation using Spirulina

Despite numerous studies on microplastics, the biological impacts of polypropylene microplastics (PP-MPs) and its toxicity on freshwater fish have yet to be fully revealed. The purpose of this research was to look at the potentially harmful effects of PP-MPs in freshwater African catfish Clarias gariepinus and bioremediation using Spirulina. After acclimatization to laboratory conditions, 108 fish (125 ± 3 gm and 27 ± 2 cm) were assigned into triplicate six experimental groups (12 fish/group), a control group, Spirulina group (SP), PP-MP-treated groups (0.14 and 0.28 mg/l PP-MPs), and PP-MP + Spirulina-treated groups (0.14 mg/l PP-MPs + 200 mg/L SP and 0.28 mg/l PP-MPs +200 mg/L SP) for 15-day exposure and 45-day recovery after that. The hematological parameters exhibiting significance (RBCs, Hct, Hb, and MCV) or non-significance (MCH and MCHC) either decreased with the increase in PP-MP doses from 0.0 in the control to 0.28 mg/L red blood cells (RBCs), hematocrit (Hct), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), hemoglobin (Hb) and platelets or increased with such an increase in doses (mean corpuscular volume (MCV)). The liver enzyme activity, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and alanine aminotransferase (ALT) exhibited non-significant (p ≥ 0.05) or significant (p < 0.05) increases in (0.14 and 0.28 mg/L) PP-MP-exposed groups, respectively, except ALP. Furthermore, there was a significant (p < 0.05) or non-significant (p ≥ 0.05) increase in 0.14 and 0.28 mg/l PP-MP +200 mg/L-exposure groups, respectively, compared to the control group and the same exposure group without Spirulina. In comparison to the control group, PP-MPs (0.14 and 0.28 mg/L) induced a significant (p < 0.05) increase in the percentage of poikilocytosis and nuclear abnormalities of RBCs. The liver tissue from fish exposed to PP-MPs exhibited varying degrees of pathological changes. These results indicated that these pathological changes increased with PP-MP concentration, suggesting that the effect of PP-MPs was dose-dependent. After 45 days of recovery under normal conditions, it was obvious that there was a significant improvement in the percentage of poikilocytosis and nuclear abnormalities of RBCs, as well as a non-significant improvement in hemato-biochemical parameters and liver tissue

Enhanced calcium entry via activation of NOX/PKC underlies increased vasoconstriction induced by methylglyoxal

Advanced glycation end-products (AGEs) play a pivotal role in macro- and micro-vascular diabetic complications. We investigated the mechanism by which methylglyoxal (an endogenous generator of AGEs) affects vascular contractility using the isolated artery technique. Contractile responses to vasoconstrictors phenylephrine (PE), angiotensin II (Ang II), vasopressin (VP) and KCl were measured in the isolated rat aorta following one-our exposure to methylglyoxal (50-200μM). The perfused rat kidney was employed to confirm the effect of methylglyoxal on microvessels. Methylglyoxal-induced changes in cytosolic calcium were measured in the smooth muscle layer of the aorta with the calcium-sensing fluorophore Fluo-4 AM. Methylglyoxal significantly increased maximal contraction of the rat aorta to PE, Ang II and VP. Similar results were seen in response to the depolarizing vasoconstrictor KCl in macro and micro vessels. The methylglyoxal-induced increases in aortic contraction mediated by the agonist and KCl were endothelium independent. Methylglyoxal-induced increases in KCl-dependent aortic contraction were abolished after the removal of extracellular calcium or in the presence of the calcium channel blocker nifedipine. Incubation with the antioxidant N-acetyl-l-cysteine (NAC), apocynin (a nonselective NADPH oxidase (NOX) inhibitor) or chelerythrine (a protein kinase C (PKC) inhibitor) prior to methylglyoxal pre-treatment reversed the methylglyoxal-induced increases in the rat aortic contractility. In conclusion, the formation of AGEs increases vasoconstriction of both macro- and micro-vessels by increasing the voltage-activated calcium entry in vascular smooth muscles in a NOX and PKC dependent manne

Adipose tissue immunomodulation: A novel therapeutic approach in cardiovascular and metabolic diseases

Adipose tissue is a critical regulator of systemic metabolism and bodily homeostasis as it secretes a myriad of adipokines, including inflammatory and anti-inflammatory cytokines. As the main storage pool of lipids, subcutaneous and visceral adipose tissues undergo marked hypertrophy and hyperplasia in response to nutritional excess leading to hypoxia, adipokine dysregulation, and subsequent low-grade inflammation that is characterized by increased infiltration and activation of innate and adaptive immune cells. The specific localization, physiology, susceptibility to inflammation and the heterogeneity of the inflammatory cell population of each adipose depot are unique and thus dictate the possible complications of adipose tissue chronic inflammation. Several lines of evidence link visceral and particularly perivascular, pericardial, and perirenal adipose tissue inflammation to the development of metabolic syndrome, insulin resistance, type 2 diabetes and cardiovascular diseases. In addition to the implication of the immune system in the regulation of adipose tissue function, adipose tissue immune components are pivotal in detrimental or otherwise favorable adipose tissue remodeling and thermogenesis. Adipose tissue resident and infiltrating immune cells undergo metabolic and morphological adaptation based on the systemic energy status and thus a better comprehension of the metabolic regulation of immune cells in adipose tissues is pivotal to address complications of chronic adipose tissue inflammation. In this review, we discuss the role of adipose innate and adaptive immune cells across various physiological and pathophysiological states that pertain to the development or progression of cardiovascular diseases associated with metabolic disorders. Understanding such mechanisms allows for the exploitation of the adipose tissue-immune system crosstalk, exploring how the adipose immune system might be targeted as a strategy to treat cardiovascular derangements associated with metabolic dysfunctions.This work was supported by AUB-Faculty of Medicine Medical Practice Plan Grant No. 320148 and an AUB President Collaborative Research Stimulus Grant to AE-Y

The Cleveland Clinic Experience with Supraclavicular and Popliteal Ambulatory Nerve Catheters

Continuous peripheral nerve blocks (CPNB) are commonly used for intraoperative and postoperative analgesia. Our study aimed at describing our experience with ambulatory peripheral nerve catheters. After Institutional Review Board approval, records for all patients discharged with supraclavicular or popliteal catheters between January 1, 2009 and December 31, 2011 were reviewed. A licensed practitioner provided verbal and written instructions to the patients prior to discharge. Daily follow-up phone calls were conducted. Patients either removed their catheters at home with real-time simultaneous telephone guidance by a member of the Acute Pain Service or had them removed by the surgeon during a regular office visit. The primary outcome of this analysis was the incidence of complications, categorized as pharmacologic, infectious, or other. The secondary outcome measure was the average daily pain score. Our study included a total of 1059 patients with ambulatory catheters (769 supraclavicular, 290 popliteal). The median infusion duration was 5 days for both groups. Forty-two possible complications were identified: 13 infectious, 23 pharmacologic, and 6 labeled as other. Two patients had retained catheters, 2 had catheter leakage, and 2 had shortness of breath. Our study showed that prolonged use of ambulatory catheters for a median period of 5 days did not lead to an increased incidence of complications

The Important Role of Optometrist and Qualified Nursing in Primary Healthcare for Eye Care

The use of evidence-based practice is essential for delivering high-quality care, ensuring patient satisfaction, and making efficient use of limited healthcare resources. Nevertheless, there have been reports of inconsistency in the administration of evidence-based eye care. To enhance our comprehension of the obstacles and enablers to delivering optometric care, it is necessary to recognize the significant role that optometrists play in providing primary eye care. This narrative study sought to identify the provision of eye care services by optometrists and measures that could enhance the delivery of eye care in primary care settings, alongside certified nursing. In the field of optometry, similar to other healthcare professions like nursing, there has been a broadening of the optometrist\u27s responsibilities in primary eye care. This includes taking on tasks such as prescription medication, which was previously done by general practitioners. Within the field of optometry, this expanded responsibility entails overseeing eye diseases that do not necessitate treatment or monitoring in secondary healthcare settings, which were historically referred to. Nevertheless, any expanded responsibility necessitates educational assistance

Integrative analysis of WDR12 as a potential prognostic and immunological biomarker in multiple human tumors

Background: Mammalian WD-repeat protein 12 (WDR12), a family member of proteins containing repeats of tryptophan-aspartic acid (WD), is a potential homolog of yeast Ytm1p and consists of seven repeats of WD.Aim of the study: This study aims to investigate the potential oncogenic effects of WDR12 in various human malignancies throughout a pan-cancer analysis that has been carried out to examine the various patterns in which this gene is expressed and behaves in tumor tissues.Methods: Herein, we used The Cancer Genome Atlas (TCGA) and various computational tools to explore expression profiles, prognostic relevance, genetic mutations, immune cell infiltration, as well as the functional characteristics of WDR12 in multiple human cancers.Results: We found that WDR12 was inconsistently expressed in various cancers and that variations in WDR12 expression predicted survival consequences for cancer patients. Furthermore, we observed a significant correlation between WDR12 gene mutation levels and the prognosis of some tumors. Furthermore, significant correlations were found between WDR12 expression patterns and cancer-associated fibroblast (CAF) infiltration, myeloid-derived suppressor cells (MDSCs), tumor mutation burden, microsatellite instability and immunoregulators. Ultimately, pathway enrichment analysis revealed that WDR12-related pathways are involved in carcinogenesis.Conclusions: The findings of our study are stisfactory, demonstrating that WDR12 could serve as a promising reliable prognostic biomarker, as well as a therapeutic target for novel cancer therapeutic approaches

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