Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement

Background There has been ongoing controversy as to whether prosthesis-patient mismatch (PPM, defined as indexed effective orifice area (EOAI) <0.85 m(2)/cm(2)) influences mortality after aortic valve replacement (AVR). In most studies, PPM is anticipated by reference tables based on mean EOAs as opposed to individual assessment. These reference values may not reflect the actual in vivo EOAI and hence, the presence or absence of PPM may be based on false assumptions. Objective To assess the impact of small prosthesis EOA on survival after aortic valve replacement AVR. Methods 645 patients had undergone an AVR between 2000 and 2007 entered the study. All patients underwent transthoracic echocardiography for determination of the actual EOAI within 6 months postoperatively. In order to predict time from surgery to death a proportional hazards model for competing risks (cardiac death vs death from other causes) was used. EOAI was entered as a continuous variable. Results PPM occurred in 40% of the patients. After a median follow-up of 2.35 years, 92.1% of the patients were alive. The final Cox regression model showed a significantly increased risk for cardiac death among patients with a smaller EOAI (HR=0.32, p=0.022). The effect of EOAI on the 2-5 year mortality risk was demonstrated by risk plots. Conclusions In contrast to previous studies these EOAI values were obtained through postoperative echocardiography, substantially improving the accuracy of measurement, and the EOAI was modelled as a continuous variable. There was a significantly improved survival for larger EOAIs following AVR. Strategies to avoid PPM should become paramount during AVR

Intraoperative pleural lavage cytology is an independent prognostic indicator for staging non–small cell lung cancer

AbstractObjectivesFor patients undergoing lung resection for cancer, macroscopic evidence of metastasis is clearly associated with adverse prognosis. However, less is known about the significance of tumor cells detected by using tests such as pleural lavage cytology. To ascertain the frequency and quantify the effect of this finding on survival, we performed a prospective study of intraoperative pleural lavage cytology.MethodsPleural lavage cytology consisted of cytologic analysis of 100 mL of saline irrigated over the lung surface immediately after thoracotomy. Patients were excluded if they had an existing effusion, extreme adhesions, or lateral chest wall invasion or if resection was not performed. Survival was calculated by means of Kaplan-Meier analysis and compared by using log-rank tests. Cox regression was used to ascertain independent predictors of prognosis.ResultsFrom 1995 through 2003, we performed pleural lavage cytology on 292 patients undergoing thoracotomy for lung cancer. The mean age was 64 (SD, 10) years, and 196 (67%) patients were men. Of 292 samples, 13 (4.5%) showed evidence of malignant cells. The median time to follow-up was 15 months (interquartile range, 1-40 months), with a median survival of 49 months for patients with negative pleural lavage cytology results and 13 months for patients with positive pleural lavage cytology results (P = .002). Univariate prognostic predictors were positive pleural lavage cytology status (P = .03), stage (P = .03), adenocarcinoma (P = .06), and parietal pleural involvement (P = .01). In the final multivariate model only positive pleural lavage cytology status (P = .006) and stage (P = .03) remained significant.ConclusionsIntraoperative pleural lavage cytology is a simple addition to intrathoracic staging and an independent predictor of prognosis. Positive results potentially affect survival by upstaging patients to stage IIIB or greater

mmWave polarization diversity wideband multiple-input/multiple-output antenna system with symmetrical geometry for future compact devices

The fifth generation (5G) of mobile networks is a significant technological advancement in telecommunications that provides faster data speeds, lower latency, and greater network capacity. One of the key technologies that enables 5G is multiple-input/multiple-output (MIMO) antenna systems, which allow for the transmission and reception of multiple data streams simultaneously, improving network performance and efficiency. MIMO is essential to meeting the demand for higher data rates and improved network performance in 5G networks. This work presents a four-element MIMO antenna system dedicated to the upper 5G millimeter-wave (mmWave) spectrum. The suggested antenna system is designed using an ultra-thin RO5880 substrate having total dimensions of 20 x 20 x 0.254 mm(3) with symmetrical geometry. The proposed antenna covers a fractional bandwidth of 46.875% (25-38 GHz), covering potential 5G bands of 26, 28, and 32 GHz, and offers isolation of >18 dB. The proposed MIMO system is fabricated and tested in-house. The antenna showed efficiency >88% at the potential band of interest and a peak gain of 3.5 dBi. The orthogonal arrangement of the resonating elements provides polarization diversity. Also, the MIMO parameters obtained, such as mean effective gain (MEG), envelope correlation coefficient (ECC), diversity gain (DG), channel capacity loss (CCL), and total active reflection coefficient (TARC), are found to have good performance. The measured results obtained are found to be in good agreement with simulations, hence making the proposed MIMO antenna suitable for handheld mmWave 5G devices.Prince Sultan University, Riyadh, Saudi Arabi

Preparedness of Australian and British nurses and midwives about domestic violence and abuse

BACKGROUND: Domestic violence and abuse (DVA) is a major health problem that affects individuals across the world. Nurses, midwives and healthcare providers need to be confident and competent in identifying and responding to DVA. AIMS: To measure current levels of knowledge, opinions and preparedness towards DVA and how it is managed by registered nurses and midwives residing in Australia and the UK. METHODS: A cross-sectional study design was used. Data were collected using the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) measuring the perceived preparation and knowledge, actual knowledge, opinions and practice issues. Australian data were collected in 2018 and UK data were collected in 2017-2018. Descriptive and inferential statistics were used to analyse the data and differences in knowledge and attitudes of British and Australian nurses. FINDINGS: Nurses and midwives (n = 368; 130 from Australia; 238 from the UK) responded to the survey. Minimal previous DVA training was reported by the participants. Participants had minimal knowledge about DVA, though had a positive attitude towards engaging with women experiencing DVA. DISCUSSION: Most participants felt unprepared to ask relevant questions about DVA and had inadequate knowledge about available resources. Australian participants scored better than British participants; however, the mean difference in all aspects remained statistically insignificant. CONCLUSION: Australian and British nurses and midwives have a positive attitude towards women experiencing DVA; however, the knowledge and skills to support women experiencing DVA are limited. IMPLICATIONS FOR NURSING POLICY: Nursing institutions should develop strategic policies regarding mandatory preparation and training of nurses for domestic violence assessment and management

New Pyrimidinone Bearing Aminomethylenes and Schiff Bases as Potent Antioxidant, Antibacterial, SARS-CoV-2, and COVID-19 Main Protease M Pro Inhibitors: Design, Synthesis, Bioactivities, and Computational Studies

New 2-thioxopyrimidinone derivatives (A1–A10) were synthesized in 87–96% yields via a simple three-component condensation reaction. These compounds were screened extensively through in vitro assays for antioxidant and antibacterial investigations. The DPPH assays resulted in the excellent potency of A6–A10 as antioxidants with IC50 values of 0.83 ± 0.125, 0.90 ± 0.77, 0.36 ± 0.063, 1.4 ± 0.07, and 1.18 ± 0.06 mg/mL, which were much better than 1.79 ± 0.045 mg/mL for the reference ascorbic acid. These compounds exhibited better antibacterial potency against Klebsiella with IC50 values of 2 ± 7, 1.32 ± 8.9, 1.19 ± 11, 1.1 ± 12, and 1.16 ± 11 mg/mL for A6–A10. High-throughput screenings (HTS) of these motifs were carried out including investigation of drug-like behaviors, physiochemical property evaluation, and structure-related studies involving DFT and metabolic transformation trends. The radical scavenging ability of the synthesized motifs was validated through molecular docking studies through ligand–protein binding against human inducible nitric oxide synthase (HINOS) PDB ID: 4NOS, and the results were promising. Furthermore, the antiviral capability of the compounds was examined by in silico studies using two viral proteins PDB ID: 6Y84 and PDB ID: 6LU7. Binding poses of ligands were discussed, and amino acids in the protein binding pockets were investigated, where the tested compounds showed much better binding affinities than the standard inhibitors, proving to be suitable leads for antiviral drug discovery. The stabilities of the molecular docked complexes in real systems were validated by molecular dynamics simulations

Acute leukaemoid reaction following cardiac surgery

Chronic myelomonocytic leukaemia is an atypical myeloproliferative disorder with a natural history of progression to acute myeloid leukaemia, a complex and poorly understood response by the bone marrow to stress. Cardiac surgery activates many inflammatory cascades and may precipitate a systemic inflammatory response syndrome. We present a case of undiagnosed chronic myelomonocytic leukaemia who developed rapidly fatal multi-organ dysfunction following cardiac surgery due to an acute leukaemoid reaction

FREQUENCY AND SOURCE OF INFECTION IN PATIENTS WITH SEPSIS

Objective: To determine the frequency and source of infection in patients with sepsis. Patients and Methods: This one year cross sectional study was carried at tertiary care teaching hospital. The criteria for selection is any patient of ≥12 years of age, either gender admitted in ward who came under the criteria for sepsis accordingly as systemic inflammatory response syndrome due to infection as existent etiology or at least with clinical evidence of infection while the necessary specific and relevant investigations were also advised and sort accordingly whereas the blood and urine sample for bacterial culture / sensitivity was collected and sent soon to confirm the diagnosis. The frequency and percentages was calculated while the numerical statistics were used to compute mean ±SD. Results: During one year study period total fifty patients diagnosed with sepsis with the mean age ±SD for whole population was 40.84±6.85 years, of fifty individuals 28 (56%) were males and 22 (44%) were females and majority belonged to rural population (60%). The organ system dysfunction identified were coagulopathy (50%), central nervous system (40%), hepatic (38%) and renal (42%). The common source of infection detected were Respiratory tract infection (16%), urinary tract infections (16%), intravenous catheters (16%) and urethral catheterization (18%) respectively. Conclusion: The study detected higher incidence of infection with gram negative pathogen was common microorganism while the common source of infections identified urethral catheterization (18%), intravenous catheters (16%), urinary tract infections (16%) and respiratory tract infections (16%). Keywords: Sepsis, Blood culture, Source of infection & Systemic inflammatory response syndrome

Biological efficacy of low versus medium dose aspirin after coronary surgery: results from a randomized trial [NCT00262275]

BACKGROUND: The beneficial effect of aspirin after coronary surgery is established; however, a recent study reported the inability of low doses (100 mg) to inhibit postoperative platelet function. We conducted a double-blind randomised trial to establish the efficacy of low dose aspirin and to compare it against medium dose aspirin. METHODS: Patients undergoing coronary surgery were invited to participate and consenting patients were randomised to 100 mg or 325 mg of aspirin daily for 5 days. Our primary outcome was the difference in platelet aggregation (day 5 – baseline) using 1 μg/ml of collagen. Secondary outcomes were differences in EC50 of collagen, ADP and epinephrine (assessed using the technique of Born). RESULTS: From September 2002 to April 2004, 72 patients were randomised; 3 patients discontinued, leaving 35 and 34 in the low and medium dose aspirin arms respectively. The mean aggregation (using 1.1 μg/ml of collagen) was reduced in both the medium and low dose aspirin arms by 37% and 36% respectively. The baseline adjusted difference (low – medium) was 6% (95% CI -3 to 14; p = 0.19). The directions of the results for the differences in EC50 (low – medium) were consistent for collagen, ADP and epinephrine at -0.07 (-0.53 to 0.40), -0.08 (-0.28 to 0.11) and -4.41 (-10.56 to 1.72) respectively, but none were statistically significant. CONCLUSION: Contrary to recent findings, low dose aspirin is effective and medium dose aspirin did not prove superior for inhibiting platelet aggregation after coronary surgery