Effect of Long Term Pulsed Electromagnetic Field on Postmenopausal Stress Urinary Incontinence

Pulsed electromagnetic therapy is used to activate the pudendal nerve, which then activates the pelvic floor musculature, which is supposed to increase urethral closure and improve the stress urinary incontinence (SUI). Aim of the study: was to detect the long-term efficacy of pulsed electromagnetic therapy on post-menopausal SUI. Subjects and Methods: Forty postmenopausal females complaining from mild or moderate degree of SUI. They were recruited randomly from outpatient clinic of gynecological department in Al-Mataria teaching hospital, Egypt. Their ages ranged from 50 to 60 years old. The BMI of the patients was not exceeding 35 Kg/m2. They were multipara. Their deliveries were normal vaginal delivery. All women were treated by pulsed electromagnetic field 2 sessions/ week for 8 weeks. The vaginal squeeze pressure and symptoms of SUI were assessed pre-magnetic therapy, post magnetic therapy at the end of 8 weeks, follow up at 3, 6& 12 months by biofeedback (Myomed 632v) and (UDI-6) respectively. Results: The vaginal squeeze pressure was significantly increased (p= 0.001), and UDI-6 was significantly decreased (p= 0.001), at post magnetic therapy, follow up at 3, 6& 12 months when compared with their corresponding values measured pre-magnetic therapy. There was no significant difference (p\u3e 0.05) between post magnetic therapy measurements compared at different time assessment at 3, 6& 12 months. Conclusion: The encouraging results of our study supported that PEMF has long -term effect as a unique therapeutic modality for the treatment of postmenopausal SUI

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

Shisha smokers’ determinants of use, knowledge and perception towards shisha (waterpipe) smoking in Penang, Malaysia

Background: Tobacco smoking is a serious health problem worldwide. Malaysia as many of south Asian countries faces the challenge of rising tobacco consumption. Despite the apparent spread of Shisha smoking phenomenon among Malaysian population, little is known about the safety concerns and determinants of Shisha smokers in this community. Objectives: This study aimed to determine the social determinants of Shisha smoking among Malaysian population in Penang Island, Malaysia and to explore their health related knowledge and perception toward Shisha smoking. Methods: The survey was conducted using simple random sampling by randomly distributing self-administered questionnaires to consumers in Shisha lounges located in Penang Island. Statistical analyses were performed using the Statistical Package for Social Science (SPSS) version 20. Results: A total number of 171 (42.75%) of respondents participated in this study. Mean age was 21.5±4.4 years. The majority were male, Malay (79.6%, 63.1% respectively). About 97.1% of respondents smoke Shisha either alone or with tobacco cigarettes. The majority (63.1%) started Shisha smoking at an age ≤ 20 years old, always in a café' (72.2%), share Shisha smoking with others (81.6%). Only 35.9% of respondents reported smoking Shisha daily. 71% reported smoking ≤ 7 bowls per week. 50.5% claimed smoking Shisha for more than 60 minutes per session. Boredom, outing and meeting with friends and family ranked first among the motives for smoking Shisha. Regarding knowledge about Shisha smoking, the majority believes that cigarettes are more harmful, more addictive and has more nicotine than waterpipe (60.2%, 71.8% and 67%; respectively). A large proportion (66%) of respondents believes that Shisha smoking doesn't transmit hepatitis infection. The majority of respondents perceived Shisha smoking acceptable by society and parents, compared to cigarettes (67% and 60.2%; respectively). The vast majority of respondents believe that Shisha smoking relieves stress and tension (77.7%), while the minority believes that Shisha smokers have more friends than non-smokers. Regarding access to Shisha, half of respondents agreed that Shisha is easily accessible than cigarettes. The majority of respondent foresees increasing popularity of Shisha smoking in the next 5 years (83.5%). Conclusion: This study showed that there is a high prevalence of Shisha smoking among the Malaysian youth associated with false believes about its health effects. Further studies involving larger population are encouraged

Effect of Black Soldier Fly Larvae Frass as Organic Fertilizer on Postharvest Quality and Shelf Life of Open-field-grown Tomato (Solanum lycopersicon L.)

Open-field-grown tomatoes in Saudi Arabia are stressed by poor soil fertility because of the low organic matter content, low nutrient availability, and high pH. Thus, high chemical fertilizer inputs are crucial for commercial production; however, they cause economic loss as well as negatively affect environmental sustainability. The use of efficient organic fertilizers would be useful for developing more cost-effective, environmentally friendly, and sustainable agriculture. The current study evaluated the impact of Black soldier fly (Hermetia illucens L.) frass (BSFF) fertilizer applications as organic fertilizer on postharvest fruit quality and shelf life of open-field-grown F1 hybrid ‘Sinag Tala’ tomatoes compared with those grown under control treatment (received recommended doses of chemical fertilizers for tomato production under open field conditions). The experiment was conducted using a randomized complete block design with four replicates. The results showed that the application of BSFF fertilizer, especially at the higher rate (5 ton/ha; BSFF3), improved the overall quality of tomato fruit. The BSFF fertilizer treatments reduced weight loss, maintained higher firmness, antioxidants [vitamin C, total phenol content (TPC) and total flavinoid (TFC)], total soluble solids (TSS), and titratable acidity (TA) contents, and lowered the TSS/TA ratio of fruits during shelf life compared with those of the control. The decay incidence was only detected after 9 days of shelf life and was significantly lower in all the BSFF fertilizer treatments (range, 8.40%-12.05%) than in the control (15.9%). In addition, BSFF fertilizer treatments reduced both disease incidence and severity of gray mold following pathogen inoculation during shelf life compared with those of the control. These results might be attributable to the higher antioxidants content (vitamin C, TPC, and TFC) and higher polyphenol oxidase activity in BSFF-fertilized tomatoes. In conclusion, BSFF fertilizer could be used as a potential eco-friendly alternative to chemical fertilizers to improve tomato fruit quality during shelf life

Industry/University Collaboration at the University of Michigan-Dearborn: A Focus on Relevant Technology

https://deepblue.lib.umich.edu/bitstream/2027.42/154105/1/kampfner1997.pd

The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks