Prediction of Gestational Diabetes by Measuring First Trimester Maternal Serum Uric Acid Concentration

Background: Gestational diabetes mellitus (GDM) is a common complication in pregnancy, affecting more than 10% pregnancies worldwide. However, the true underlying causes remain to be fully elucidated.Aim: This study aimed at searching for any relation between first trimester uric acid concentration and the development of GDM.Subjects and Methods: The study was conducted on 250 first trimester pregnant females at risk of diabetes mellitus attending the outpatient clinic of Tanta University Hospital. All cases underwent estimation of first trimester‑fasting blood sugar and maternal serum uric acid concentration. Between 24 and 28 weeks’ gestation random blood sugar and glucose challenge test were done. Positive cases were confirmed by 3 h glucose tolerance curve.Results: The results demonstrated an association between first trimester maternal serum uric acid concentration obesity and GDM. Approximately, 41.4% (60/145) of non‑diabetic women were at first quartile, while 44.8% (47/105) of the diabetic women were at fourth quartile.Conclusion: We concluded that the cut‑off level of maternal serum uric acid of 4 mg/dl in the first trimester was associated with developing GDM. Therefore, we suggest that serum uric acid level should be done as routine test during the first antenatal care visit.Keywords: Impaired fasting glucose, multiple logistic‑regression analysis, type 2 diabetes mellitus, uric aci

Analysis of Highly Directive Cavity-Type Configurations Comprising of Low Profile Antennas Covered by Superstrates

In this paper we present a technique for designing antenna/superstrate composites to produce enhanced directivities. As a first step, we study the underlying mechanism that governs the performance of theses antennas by studying the canonical problem of a line source in a rectangular waveguide. The above problem is solved by constructing the Green’s function corresponding to the line source in the rectangular guide, one of whose walls is partially reflecting, that is can leak electromagnetic energy into the space external to the guide. The Green’s function for this problem can be constructed by aggregating the multiple reflections from the two walls. Although the above model is only two-dimensional, we show that it can be used to predict the performance of antenna/superstrate composites. We demonstrate this by modeling several highly directive antennas and show that indeed the required characteristics of this type of antennas can be determined from the analysis of the cutoff behavior of the rectangular guide

Health promotion, disease prevention and periodic health checks: perceptions and practice among family physicians in eastern Mediterranean region

Introduction: The aim of this study was to identify the current practices and perceptions of family physicians regarding health promotion, disease prevention including periodic screening and health checks in Eastern Mediterranean Region. Methods: A multi-country cross-sectional study was conducted in six countries of EMR, from September 2014 to March 2015. Family Physicians who were currently practicing in different countries of EMR were invited to participate in the study through email. A pre-tested structured questionnaire was used for data collection. Data was entered and analyzed on SPSS 19 and logistic regression analysis was performed. Results: A total of 100 physicians data was included in the final analysis. The majority were female physicians (76%): 63% were 25 to 35 years of age. Approximately 53% of Family physicians always recommend periodic screening and health checks to their patients. The common screening question asked to patients in medical history was related to their blood pressure (86%). Almost all (99%) of the Family physicians believe they should conduct periodic health checks. Those who had postgraduate training in Family Medicine (OR: 0.5; 95% CI: 0.39-1.67) and attended CME sessions regularly (OR: 0.11; 95% CI: 0.01-0.93), are more likely to recommend periodic screening and health checks to their patients. Conclusion: Periodic screening and health check is an important strategy to prevent disease and maintain health. It is an underutilized practice and a great need exists for its implementation in family practice

New leadership model for family physicians in the Eastern Mediterranean region: a pilot study across selected countries

Background: Family Medicine is growing rapidly across the Eastern Mediterranean Region. However, it needs support in terms of overall health system development. This will require strong leadership in family medicine to implement the change required to improve current conditions. Objective: To collect data that will support the development of a leadership program for the future family physicians in the region. Methods: A cross-sectional study was conducted from July 2016 to September 2016 in eight countries of the Eastern Mediterranean Region, (Bahrain, Egypt, Iraq, Jordan, Kuwait, Qatar, Pakistan, and Saudi Arabia). These countries were selected to obtain perceptions of Family Physicians (FPs) regarding the current leadership model and to explore the need for a new future innovative model in Family Medicine (FM) across the region. Results: The information of 68 family physicians was included in the final analysis. The majority of the FPs was females as compared to males (71% vs. 29%). Forty-four percent of the FPs had 10 to 19 years of experience. Almost all of the FPs (96%) had completed some training in family medicine after graduation. About three fifths of the FPs had completed postgraduate qualifications and out of those, 64% had passed Board or Membership Examinations. Twenty-one percent of them are currently in a leadership role and 45% who were not in any leadership role responded that the current situation of FM in their country is poor. All of the leaders believed that it is important to develop strong leadership in FM to take the specialty forward. Almost similar proportions (67% and 64%) of leaders and non-leaders thought that establishing regional associations would enhance the FM practice model. Approximately two thirds of leaders (67%) responded that the current role of decision makers in the Ministry of Health (MOH) regarding capacity building in FM is not effective. The majority of the FPs (54% and 38%) considers that the existing postgraduate curriculum does not address leadership skill development in FM. Eighty-eight percent of the FPs both from leadership and non-leadership groups agreed that academic institutions and practicing FPs can play an effective leadership role in taking FM forward. Conclusion: The Family Medicine specialty will have to develop leadership capabilities in line with today’s fast-moving changes in healthcare for it to obtain the due recognition in the healthcare delivery system

Predictive models for fatigue property of laser powder bed fusion stainless steel 316L

The selection of appropriate processing parameters is crucial for producing parts with target properties via the laser powder bed fusion (L-PBF) process. In this work, the fatigue properties of L-PBF stainless steel 316L under controlled changes in laser power and scan speed were studied by employing the statistical response surface method. Processing regions corresponding to different fatigue failure mechanisms were identified. The optimum fatigue properties are associated with crack initiation from microstructure defect, which, by acting as the weakest link, creates enhanced porosity-tolerance at applied stress approaching the fatigue limit. Deviations from the optimum processing condition lead to strength degradation and porosity-driven cracking. Based on the observed relations between microstructural features and failure behaviour, a processing-independent fatigue prediction model was proposed. The microstructure-driven failure was modelled by a reference S-N curve where the intrinsic effect of microstructure inhomogeneity was accounted for by applying a reduction factor on fatigue life. For the porosity-driven failure, high cycle fatigue life follows an inverse-square-root relation with porosity fraction. This relation was incorporated into the Basquin equation for predicting the fatigue strength parameters.Accepted versio

G-quadruplex-binding small molecules ameliorate C9orf72 FTD/ALS pathology in vitro and in vivo

Intronic GGGGCC repeat expansions in C9orf72 are the most common known cause of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS), which are characterised by degeneration of cortical and motor neurons, respectively. Repeat expansions have been proposed to cause disease by both the repeat RNA forming foci that sequester RNA-binding proteins and through toxic dipeptide repeat proteins generated by repeat-associated non-ATG translation. GGGGCC repeat RNA folds into a G-quadruplex secondary structure, and we investigated whether targeting this structure is a potential therapeutic strategy. We performed a screen that identified three structurally related small molecules that specifically stabilise GGGGCC repeat G-quadruplex RNA We investigated their effect in C9orf72 patient iPSC-derived motor and cortical neurons and show that they significantly reduce RNA foci burden and the levels of dipeptide repeat proteins. Furthermore, they also reduce dipeptide repeat proteins and improve survival in vivo, in GGGGCC repeat-expressing Drosophila Therefore, small molecules that target GGGGCC repeat G-quadruplexes can ameliorate the two key pathologies associated with C9orf72 FTD/ALS These data provide proof of principle that targeting GGGGCC repeat G-quadruplexes has therapeutic potential

HCV Infection among Saudi Population: High Prevalence of Genotype 4 and Increased Viral Clearance Rate

HCV is a major etiological agent of liver disease with a high rate of chronic evolution. The virus possesses 6 genotypes with many subtypes. The rate of spontaneous clearance among HCV infected individuals denotes a genetic determinant factor. The current study was designed in order to estimate the rate of HCV infection and ratio of virus clearance among a group of infected patients in Saudi Arabia from 2008 to 2011. It was additionally designed to determine the genotypes of the HCV in persistently infected patients. HCV seroprevalence was conducted on a total of 15,323 individuals. Seropositive individuals were tested by Cobas AmpliPrep/Cobas TaqMan HCV assay to determine the ratio of persistently infected patients to those who showed spontaneous viral clearance. HCV genotyping on random samples from persistently infected patients were conducted based on the differences in the 5′untranslated region (5′UTR). Anti-HCV antibodies were detected in 7.3% of the totally examined sera. A high percentage of the HCV infected individuals experienced virus clearance (48.4%). HCV genotyping revealed the presence of genotypes 1 and 4, the latter represented 97.6% of the tested strains. Evidences of the widespread of the HCV genotype 4 and a high rate of HCV virus clearance were found in Saudi Arabia

Ensemble Analysis of Angiogenic Growth in Three-Dimensional Microfluidic Cell Cultures

We demonstrate ensemble three-dimensional cell cultures and quantitative analysis of angiogenic growth from uniform endothelial monolayers. Our approach combines two key elements: a micro-fluidic assay that enables parallelized angiogenic growth instances subject to common extracellular conditions, and an automated image acquisition and processing scheme enabling high-throughput, unbiased quantification of angiogenic growth. Because of the increased throughput of the assay in comparison to existing three-dimensional morphogenic assays, statistical properties of angiogenic growth can be reliably estimated. We used the assay to evaluate the combined effects of vascular endothelial growth factor (VEGF) and the signaling lipid sphingoshine-1-phosphate (S1P). Our results show the importance of S1P in amplifying the angiogenic response in the presence of VEGF gradients. Furthermore, the application of S1P with VEGF gradients resulted in angiogenic sprouts with higher aspect ratio than S1P with background levels of VEGF, despite reduced total migratory activity. This implies a synergistic effect between the growth factors in promoting angiogenic activity. Finally, the variance in the computed angiogenic metrics (as measured by ensemble standard deviation) was found to increase linearly with the ensemble mean. This finding is consistent with stochastic agent-based mathematical models of angiogenesis that represent angiogenic growth as a series of independent stochastic cell-level decisions

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe