Echocardiographic assessment of the right ventricle and its correlation with patient outcome in acute respiratory distress syndrome

Introduction: Acute respiratory distress syndrome (ARDS) is a life-threatening chest disease associated with a poor outcome and increased mortality. It may lead to pulmonary hypertension and, eventually, right ventricular failure. These changes can be investigated by transthoracic echocardiography (TTE) which is considered a non-invasive and cost-effective modality. We studied the role of right ventricular function in the prediction of the severity and mortality in ARDS. Material and methods: In this observational study, 94 patients suffering from ARDS were subjected to TTE to evaluate the parameters of right ventricular function by measuring tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV-FAC), myocardial performance index (Tei index), and systolic pulmonary artery pressure (SPAP) to assess their relation to the severity and mortality in ARDS. Results: TAPSE, SPAP, Tei index, and RV-FAC showed significant differences between survivors and non-survivors after 30 days (all p < 0.001). An increased length of intensive care unit stay was significantly correlated with TAPSE, Tei index, and RV-FAC (p = 0.002‚ 0.007‚ and 0.013, respectively). Meanwhile, the length of mechanical ventilation days was significantly correlated with the Tei index only (p < 0.001). Multivariate regression analysis found that TAPSE and the Tei index were independent factors affecting mortality (p = 0.004‚ and 0.006, respectively). RV-FAC, with a cut-off point ≤ 57%, had the highest sensitivity‚ while TAPSE, with a cut-off point ≤ 17 mm, had the highest specificity to predict mortality.Conclusions: Transthoracic echocardiographic parameters of the right ventricle could be used to predict severity and mortality in patients with ARDS with high sensitivity and specificity

Comparing the success rate of external dacryocystorhinostomy with anterior flap versus flap excision in managing chronic dacryocystitis

Background: Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute dacryocystitis. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic dacryocystitis secondary to NLDO. Methods: In this retrospective, non-randomized, interventional, comparative study of patients with chronic dacryocystitis secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups. Results: We included 53 patients with a male-to-female ratio of 16 (30.2%) to 37 (69.8%); 25 eyes underwent flapless DCR (group 1) and 28 eyes underwent anterior flap suturing DCR (group 2). The two groups had comparable demographic characteristics (all P > 0.05). Furthermore, anatomical (92.0% in group 1 and 92.9% in group 2) and functional (84.0% in group 1 and 92.9% in group 2) success rates at final follow-up were comparable between groups (both P > 0.05). At the one-month postoperative examination, premature tube extrusion was more often reported in group 1 (12.0%) compared to group 2 (7.1%). At the two-month follow-up examination, tube extrusion was noted in 4.0% in group 1 and 0.0% in group 2, yet the difference failed to attain statistical significance (P > 0.05). Conclusions: We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic dacryocystitis. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified

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

Highly efficient GaN Doherty power amplifier for N78 sub-6 GHz band 5G applications

In this paper, a high-efficiency GaN Doherty power amplifier (DPA) for 5G applications in the N78 sub-6 GHz band is introduced. The theoretical analysis of the matching networks for the peak and carrier transistors is presented, with a focus on the impact of unequal power splitting for both transistors and the recommendation of a post-harmonic suppression network. The proposed design features an unequal Wilkinson power divider at the input and a post-harmonic suppression network at the output, both of which are crucial for achieving high efficiency. The Doherty power amplifier comprises two GaN 10 W HEMTs, measured across the 3.3 GHz to 3.8 GHz band (the N78 band), and the results reveal significant improvements in gain, output power, drain efficiency, and power-added efficiency. Specifically, the proposed design achieved a power gain of over 12 dB and 42 dBm saturated output power. It also achieved a drain efficiency of 80% at saturation and a power-added efficiency of 75.2%. Furthermore, the proposed harmonic suppression network effectively attenuated the harmonics at the output of the amplifier from the second to the fourth order to more than −50 dB, thus enhancing the device’s linearity

Zootherapy: A study from the Northwestern region of the Kingdom of Saudi Arabia and the Hashemite Kingdom of Jordan

561-569This paper provides an overview of the traditional uses of animal species and their derivatives in traditional folk medicine from Tabuk area located at the North western region of the Kingdom of Saudi Arabia and the Hashemite Kingdom of Jordan. Potential implications for conservation of species used are also discussed, as several species used in folk medicine are threatened for extinction. We conducted interviews with local communities, hunters and druggist to collect information on various species of animals or their derivatives used and the remedies prepared from them. Results showed that at least 22 taxonomic orders of animals (13 vertebrates and 9 invertebrates) are used for medicinal purposes. In addition, 28 categories of raw materials that formed the basis of traditional medicine were also prescribed for treating locally diagnosed aliments. This survey is important as it defines species of animals used in folk medicine, from a region which is insufficiently studied. Although the extent of traditional folk medicine is still in debate, but their conservation management should be addressed, as an indiscriminate use of these animal species may contribute in decrease of their populations, especially in case of carnivores

Algorithms for Solving Nonhomogeneous Generalized Sylvester Matrix Equations

This paper considers a new method to solve the first-order and second-order nonhomogeneous generalized Sylvester matrix equations AV+BW= EVF+R and MVF2+DV F+KV=BW+R, respectively, where A,E,M,D,K,B, and F are the arbitrary real known matrices and V and W are the matrices to be determined. An explicit solution for these equations is proposed, based on the orthogonal reduction of the matrix F to an upper Hessenberg form H. The technique is very simple and does not require the eigenvalues of matrix F to be known. The proposed method is illustrated by numerical examples

Systematics, distribution and ecological analysis of rodents in Jordan

Amr, Zuhair S., Abu, Mohammad A., Qumsiyeh, Mazin, Eid, Ehab (2018): Systematics, distribution and ecological analysis of rodents in Jordan. Zootaxa 4397 (1): 1-94, DOI: https://doi.org/10.11646/zootaxa.4397.1.

Echocardiographic Assessment of the Right Ventricle and Its Correlation with Patient Outcome in Acute Respiratory Distress Syndrome

Introduction: Acute respiratory distress syndrome (ARDS) is a life-threatening chest disease associated with a poor outcome and increased mortality. It may lead to pulmonary hypertension and, eventually, right ventricular failure. These changes can be investigated by transthoracic echocardiography (TTE) which is considered a non-invasive and cost-effective modality. We studied the role of right ventricular function in the prediction of the severity and mortality in ARDS. Material and methods: In this observational study, 94 patients suffering from ARDS were subjected to TTE to evaluate the parameters of right ventricular function by measuring tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV-FAC), myocardial performance index (Tei index), and systolic pulmonary artery pressure (SPAP) to assess their relation to the severity and mortality in ARDS. Results: TAPSE, SPAP, Tei index, and RV-FAC showed significant differences between survivors and non-survivors after 30 days (all p < 0.001). An increased length of intensive care unit stay was significantly correlated with TAPSE, Tei index, and RV-FAC (p = 0.002‚ 0.007‚ and 0.013, respectively). Meanwhile, the length of mechanical ventilation days was significantly correlated with the Tei index only (p < 0.001). Multivariate regression analysis found that TAPSE and the Tei index were independent factors affecting mortality (p = 0.004‚ and 0.006, respectively). RV-FAC, with a cut-off point ≤ 57%, had the highest sensitivity‚ while TAPSE, with a cut-off point ≤ 17 mm, had the highest specificity to predict mortality. Conclusions: Transthoracic echocardiographic parameters of the right ventricle could be used to predict severity and mortality in patients with ARDS with high sensitivity and specificity

Population density of the Blanford's fox Vulpes cana in Jordan

A survey of the Blanford's fox was established in Jabal Masuda (Southern Jordan), to increase the knowledge of its density. Live-trapping method was used and capture mark-recapture technique was applied. We captured a total of 27 specimens including nine re-captured specimens. Density was determined using two methods: the Bondrup-Nielsen formula which identified 8.5 individuals per km², and the ArcGIS tools which showed values, between 0.177 to 9 individuals per km². This paper is the first to give measured information on the Blanford's fox density in Jordan. As well, it showed that ArcGIS 9.3 Spatial Analyst Extension is an effective tool in establishing information on density in large spatial areas. The information provided could serve as a base for future monitoring of the Blanford's fox's range of occurrence