A validation of a re-equilibrium decisionsupport system for PPP contracts

[abstract not available]https://fount.aucegypt.edu/faculty_book_chapters/1274/thumbnail.jp

High Atherogenic Index of Plasma at-admission of COVID-19 patients can predict Upcoming Cardiac Morbidity and Mortality in Non-Cardiac patients

Background: The coronavirus disease 2019 showed multiple modifications since the start of the pandemic not only in the viral structure but also in its clinical presentation. Cardiac presentation and infection of cardiac patients is serious and necessitates early prediction Objectives: Evaluation of the relation between incidentally detected dyslipidemia at-admission of COVID-19 non-cardiac patients and their outcome. Patients and methods: Plasma lipid profile and the Atherogenic Index of Plasma [AIP] were determined in 302 COVID confirmed patients. Patients were evaluated using the COVID-GRAM [CG] critical illness score and during hospital stay the rates of admission to intensive care unit [ICU], development of cardiac insults and need for admission to cardiac ICU [CCU] and its outcome were determined. Results: 114 patients were dyslipidemic with increasing incidence with increased disease severity. The AIP cardiac risk was high in 92 and the CG critical illness risk was medium in 231 patients. Forty-seven and 63 patients were admitted to the CCU and ICU, respectively, and unfortunately; 21 and 22 patients died at CCU and ICU, respectively. High at-admission CG-risk percentage was defined as predictor for progress to critical grade by 63% and total mortality by 37%, while high at-admission AIP score was the only important predictor for mortality secondary to cardiac insult. Conclusion: Dyslipidemia was detected in about 40% of low cardiac risk COVID patients and about 15.6% developed cardiac insult and 7% had died. Combined estimation of AIP and CG scores might accurately differentiate patients liable to develop cardiac complications and predict both mortalities

Non-Invasive Panel for Prediction of Large Esophageal Varices in Patients with HCV-Related Cirrhosis after DAAS Therapy

To study sonographic and laboratory parameters as diagnostic non-invasive Indices for prediction and screening of large varices in liver cirrhotic patients post hepatitis C virus after direct Actin antiviral drugs (DAAS). Introduction: All cirrhotic patients should be screened for esophageal varices (EV) via endoscopy, as recommended by the guidelines. However, repeated endoscopy is not well accepted by patients and is a costly procedure that places a heavy burden on the endoscopic unit. Therefore, noninvasive predictors of EVs and size discrimination for EVs are of particular importance.After dividing DAAS into three arms: arm 1 with Non-EV, arm 2grad1&2 EV (Small Vriceal arm), and arm 3 grade 3&4 EV (Large Variceal arm). medical history, physical examination, standard laboratory tests, abdominal ultrasound, and sonographic parameters such as portal vein velocity (PVV). Splenic Index (SI) Splenoportal Index (SPI), platelet count/spleen diameter ratio (PCSDR) and upper gastrointestinal endoscopy were performed for all participants.Results: The Noninvasive sonographic and laboratory parameters for prediction of the presence of EVs have demonstrated that low platelet count/spleen diameter ratio (PC/SD) at cut-off (CO) ≤ 1121.43 cu/mm, then high SPI at CO >3.98 cm /sec then high FIB4 at CO > 2.68 then high APRI at CO > 0.6 then PVV at CO ≤ 22.2 cm/sec then high SI at CO > 89.7 and lastly Child’s – Pugh’s score at CO > 6 respectively.. The Non Invasive sonographic and laboratory parameters for discrimination of the size of EVs showed that high SPI was found to be the most accurate parameter at CO less than >7.75 cm/sec Then low PC/SD at CO ≤ 514.08 cu/mm then high APRI at CO > 1.4 then high FIB4 at CO > 7,6 then high SI with AUC 0.821 at CO > 122.4 then low PVV at CO < 15 and lastly Child’s –Pugh’s score at CO> 6 respectively.Conclusions: The sonographic and laboratory indices are non- invasive parameters for the prediction of EV & discrimination of its size. And to determine when Upper Endoscopy is done for liver cirrhotic patients post-C after DAA

MAT-725: SELF LEVELING MORTAR: WHY AND HOW?

Concrete floors can develop faults over time which can cause damage thus hindering smooth transportation, industrial aspects and some residential drawbacks. In addition, flaws and cracks are known to progress into more serious damage with time and use. Self leveling mortar has been used on a relatively limited scale worldwide to allow for more even, higher performance and easy-to-apply flooring. However, there has been little information available with respect to their use and best practices. The primary focus of this work is to prepare mortar that possesses self-levelling flow characteristics. Hence, several mixtures have been designed using various constituents with moderate 28-day strength of 35 MPa. Chemical and mineral admixtures have been incorporated together with limestone to enhance the flow and cohesiveness as well as improve performance. The results reveal that self-levelling mortar can be successfully produced with comparable properties to ready-to-use market product. These mixtures were evaluated to have both performance and economic merits

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

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

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

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 &lt; 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