Routing Techniques in Data Center Networks

Data Centers are the core of cloud computing as they consist of thousands of com-puters which are interconnected in a way to provide cloud services. A Data Center Network (DCNs) can be defined as centralized infrastructure providing several large scale computing and diversified network services like video streaming and clou

Attitudes and perceptions towards hypoglycaemia in patients with diabetes mellitus: A multinational cross-sectional study.

BackgroundPreventing hypoglycaemia is an essential component of diabetes self-management that is affected by patients' attitudes and perceptions. This study aimed to explore the hypoglycaemia problem-solving ability of patients who have diabetes mellitus and factors that determine their attitudes and perceptions towards their previous events.MethodologyA cross-sectional study was conducted between October 2017 and May 2018 in three Arab countries (Jordan, Saudi Arabia and Kuwait) in patients with diabetes mellitus, who were prescribed antidiabetic therapy and had experienced hypoglycaemic events in the past six months. The Hypoglycaemia Problem-Solving Scale was used in this study. This scale contains two subscales, problem orientation (six questions) and problem-solving skills (eighteen questions), using a five-point Likert scale (range 0-4). Multiple linear regression analysis was used to identify predictors of hypoglycaemia problem-solving abilities.ResultsA total of 895 patients participated in this study from the three countries (300 in Jordan, 302 in Saudi Arabia, and 293 in Kuwait). The average age of the patients was 53.5 years (standard deviation = 13.7) and 52.4% (n = 469) were males. Patients had moderate overall problem-solving ability with a median score of 63.00 (interquartile range = 13.00). Patients' problem-solving skills score (68.1%) was better than their problem-orientation skills score (58.3%). The highest sub-scale scores were for detection control, setting problem-solving goals, and evaluating strategies, 75.0%. The lowest sub-scale score was for problem-solving perception and immediate management, 50.0%. Older age, being educated, being married, having T2DM, prescribed insulin therapy, and not having been admitted to hospital for hypoglycaemia were important predictors of patients' problem-solving ability (p ConclusionsHealthcare professionals are advised to provide more education to patients on how to self-manage hypoglycaemic events. Specifically, they should focus on the overall problem-solving perception of hypoglycaemia and its immediate management

One-year real-world outcomes for patients undergoing transcatheter mitral valve repair: the Gulf MTEER registry (GULF Mitral Transcatheter Edge to Edge Repair)

Background Severe mitral regurgitation (MR) with left ventricular dysfunction portends worse outcomes. Over the course of the last two decades, transcatheter repair of the mitral valve offered an alternative therapeutic modality for those deemed inoperable or high risk. Landmark studies such as the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation and Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation trials have shown conflicting results with respect to all-cause death and heart failure rehospitalisations. The Gulf Mitral Transcatheter Edge to Edge Repair registry (Gulf MTEER registry) is a regional registry that captured outcomes in those undergoing transcatheter repair of the mitral valve. The objectives of this study were to describe the baseline characteristics of patients undergoing transcatheter mitral valve repair in the Gulf region and estimate the cardiovascular effects of the mitral transcatheter therapies in routine practice.Methods The Gulf MTEER registry is an observational, multicentre, retrospective registry that enrolled all patients undergoing transcatheter repair of the mitral valve from four of the Gulf countries (Saudi Arabia, Kuwait, Bahrain, Oman) between 1 January 2017 and 31 December 2019. Baseline characteristics, echocardiographic parameters and immediate procedural success were reported. The primary outcome was a composite of death and rehospitalisations at 1 year. The secondary outcomes were the individual components of the composite endpoint; that is, death and rehospitalisations at 1 year as well as residual or recurrent MR or worsening New York Heart Association class and a need for repeat repair.Results A total of 176 patients were enrolled. Men constituted 56.3% of the total. At 1 year the primary outcome occurred in 21.1% (95% CI 15.6, 27.9). The secondary outcomes of death occurred in 5.4% (CI 2.9, 10.0) and rehospitalisations occurred in 16.9% (CI 11.9, 23.3). Univariate analysis revealed that the odds of having death or re-hospitalisation was two times higher if the effective regurgitant orifice (ERO) >40 mm2 irrespective of the therapy.Conclusions The Gulf MTEER registry is the first registry in the Gulf region defining the patient population receiving MTEER therapies and evaluating 1-year outcomes. This is a low risk cohort with a high rate of immediate procedural success and low rate of all-cause death and rehospitalisations at 1 year. The odds of an event was two times higher if the ERO ≥40 mm2 with only a signal to higher odds for low left ventricular ejection fraction and larger end systolic dimension

ANTICOAGULANTS AND THROMBOLYTICS IN PREGNANCY, A SYSTEMATIC REVIEW

Background: In the developed countries, pulmonary thromboembolism associated with pregnancy (VTE) continues to be the principal cause of direct maternal death. Despite thorough treatment and preventative recommendations from several national authorities, reductions in mortality due to VTE have been negligible. Anticoagulation is still the cornerstone of prenatal care and has to be given to all patients with proven or high-risk PE. The preferred medication is low molecular weight heparin (LMWH), which has a known pharmacodynamic profile. Despite the massive utilization of these drugs there is actually little evidence supporting their efficiency in recurrent pregnancy loss reduction. Objectives: The study aims to summarize current evidences regarding the usage of anticoagulants and thrombolytics in Pregnancy. Methods: For article selection, the PubMed database and EBSCO Information Services were used. All relevant articles relevant with our topic and other articles were used in our review. Other articles that were not related to this field were excluded. The data was extracted in a specific format that was reviewed by the group members. Conclusion: A common cause of maternal death, pulmonary embolism-related fatalities still occur often in pregnant women with pulmonary embolism. One-third of pregnant women with pulmonary embolism and hemodynamic failure were reported to undergo systemic thrombolysis. There is an urgent need to improve prevention and care techniques for this vulnerable patient population. LMWHs are widely used for several different purposes as well as for the treatment and prevention of VTE during pregnancy and puerperium. Although the medicine has been found to be both safe and effective, there is no scientific proof to support its usage for all indications. In pregnant women with thrombophilia who are at high risk of developing these issues, prenatal prophylactic dalteparin does not prevent venous thromboembolism, pregnancy loss, or placenta-mediated pregnancy difficulties and is linked to an increased risk of mild bleeding. Enoxaparin may not offer any meaningful benefits to people suffering from recurrent abortion. However, in one study, the miscarriage rate was significantly lower when enoxaparin was used compared with untreated controls