Chest Pain of Uncertain Aetiology: Role of Contrast Enhanced Computed Tomography in the Emergency Department

There is increasing role of computed tomographic (CT) in the assessment of acute chest pain in the emergency department especially when the diagnosis is not clear. We report a case where non ECG gated contrast enhanced CT in the emergency department for rule-out of pulmonary embolus guided to the actual diagnosis, which was, acute coronary event, as evidenced by the presence of perfusion defect

Imaging aortic regurgitation: The incremental benefit of speckle tracking echocardiography

Aortic regurgitation (AR) affects global left ventricular mechanics. However, limited literature is available on how it may affect regional longitudinal strain. We present a case where severe AR jet is thrashing the anterior-septal wall and reducing its overall longitudinal performance most likely secondary to increased wall shear stress in diastole. This new insight into patho-physiological process using deformation study may have supplementary impact in decision making for surgical intervention. Transthoracic echocardiography is the primary imaging modality for the assessment of AR as it offers evaluation of severity of AR, aetiology of AR, left ventricular (LV) dilatation, LV systolic function, left ventricular mass, diastolic function and global strain. This case highlights the regional disturbances in longitudinal strain in eccentric AR

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Agricultural Risks and Risk Management of Different Farming Systems in Syria

Syria is an agricultural developing country, characterized by semi-arid climate and high population growth rate, facing challenges related to mainly agriculture sector and food insecurity. The resolution of the latter is one of the Millennium Development Goal, which can be explicated by the goal to “eradicate extreme poverty and hunger”. Within such a framework the present thesis is devoted to study the food security situation in Syria and the peculiar factors affecting the income of the poor household. In specific, the work investigates food security situation and explores the agricultural risks by studying their main types, current strategies, public management policies and the future possible improvements for risk management. A variety of analytical approaches have been used since the main methodologies for carrying out the research depending essentially on quantitative as qualitative analyses. As preliminary analysis, secondary data were used to investigate the food security situation, while secondary data on farm semi-structured survey and an ad hoc Delphi method survey have been implemented to examine the agricultural risks and risk management strategies. The food security situation seems very similar to that of other Middle Eastern countries like Jordan and Lebanon. Food aggregate and per capita availability have an acceptable level which is also applied to food accessibility and supply stability. In contrast, food utilization exhibits low level compared to other countries, and lies under the world average in some cases e.g. for many vitamins intake. Therefore, The Government of Syria (GOS) should fill in the gap of food deficiencies both by developing the agricultural products and introducing reforms to the trade sector especially those related to importing/exporting food stuff. The agricultural risks in Syria are related mainly to production, price and policy change risks. The mentioned risks are quite different both in type and intensity according to the different zones (Farming Systems). The yield risks result mostly from the increasing incidence of drought, frost, storm, flood and diseases, while price risks are related largely to the marketing constraints of the freely marketed crops (e.g. citrus, fruits and vegetables). Policy change risks (e.g. changes in macroeconomic policies or input/output prices) affect mainly the strategic crops (cotton, wheat and sugar beet) that are marketed by the state. Finally, idiosyncratic risks (individual or personal) seem not very relevant, on average, at the national level. Agricultural risk management policies and strategies are also different according to Syrian zones. In general, diversification of income sources and cultivated crops are the main strategies adopted by farmers, while adopting a risk sharing strategy like “agricultural insurance” is still unfavorable one. Finally, GOS institutions contribute to agricultural risk management by several means like the agricultural supporting policies including the agricultural disasters relief. However, much effort must be done by GOS to manage the agricultural risks including the establishment of agricultural insurance framework

Evaluation of the efficacy of antibiotics in the treatment of Staphylococcus aureus isolated from clinical cases in Al-Dawwaniyah hospitals

Staphylococcus aureus, especially resistant to methicillin, is one of the Basic causes of hospital infection, its resistance to antibiotics has constituted a public health problem worldwide, due to the lack of studies related to the examination of sensitivity to antibiotics, especially in methicillin-resistant species in Iraq and in the city of Diwaniyah in particular. Therefore,The current study aimed to find out the prevalence rate antibiotic resistance in these bacteria isolated from different clinical sources in some hospitals in the governorate. During the research, 554 clinical samples (221 urine samples, 178 sputum samples, 100 burns samples and 55 injuries) for the period from the 11th of 2021 to the 3rd of 2022. Relying on the results of in vitro culture and conventional microscopic and biochemical assays, 100 isolates of Staphylococcus aureus were identified, using the cefoxetine disc spread method, as 80 isolates belong to MRSA. The results of the antibiotic susceptibility test were examined retrospectively. Using the method (Kirby Bauer) using 20 antibiotics used in the current study and it was found that (78%) Of these bacteria were multidrug resistant (MDR).&nbsp

Isolation and study of MRSA-resistant Staphylococcus aureus from clinical samples in Al-Diwaniyah Hospitals

This study included the collection of 554 samples from different clinical sources and cases for patients of different ages, visit the different Diwaniyah hospitals for the period from November 2021 to March 2022. Staphylococcus aureus was investigated. The results showed the yield of 100 isolates of S aureus bacteria, which included 11 isolates from burns, 11 from wounds, 24 from sputum, and 55 from urine. MRSA was investigated using the method of spreading on the agar, and it was 80%, 50% urine, 25% sputum, 13% burns, and 11%wound. An antibiotic assay was done towards MRSA isolates, and the percentages were as follows: Penicillin 100%, Cefoxitin 100%, Moxifloxacin (MFX) 76.2%, Erythromycin 70%, azithromycin 63.7%, levofloxacin 51.5, CLARITHROMYCIN Amikacin 41, 38% 12, Clindamycin 287%, Ofloxacin 41.2%, Tetracycline 36.2%, Doxycycline 31.2%, Rifampin 23.7%, Norfloxacin 18.7%,Trimethoprim 18.7%, Gentamicin 13,3% Trimethoprim-Sulfamethoxazole 12 and Ciprofloxacin and 12% and Nitrofurantoin 10% and Chloramphenicol 6.1%, while the values ​​of the MAR index ranged from 0.75 to 0.0

Tracking Food Security in the Arab Region

The publication presents and applies the Arab Regional Food Security Monitoring Framework developed by the Economic and Social Commission of Western Asia (ESCWA). The Framework aims to help countries effectively assess their food security situation. It was developed in collaboration and partnership with Arab countries, the Arab Organization for Agricultural Development (AOAD) and the Food and Agriculture Organization of the United Nations (FAO) and experts with support from the Swedish International Development Cooperation Agency (Sida). It accounts for the complexity and multidimensionality of food security along its multi-pronged definition and allows the monitoring of selected targets of the Sustainable Development Goals. The framework tracks food security through three outcome indicators grouped under a core pillar and 21 causal indicators distributed along the four food security dimensions of availability, access, utilisation and stability. The publication outlines the Framework’s development process and rationale for selecting the indicators and introduces an innovative way to show results in the form of a dashboard composed of a double doughnut chart visualising performance and a table summarising key statistics and trends. It also presents the key results of tracking food security at the Arab regional level and the trend over the considered years. It shows that the region records poor performance for all three of the outcome indicators of undernourishment, food insecurity experience and obesity while also presenting the performance and trends for the remaining 21 other indicators. It identifies yields, food import dependency, logistics, food price volatility and low political stability as hotspots needing urgent action, among others. It also reveals declining trends in the prevalence of undernourishment and obesity as well as dietary energy supply, use of water in agriculture and unemployment, to name a few. The publication includes an indicator-by-indicator analysis and outlines selected recommendations

A Secure and Lightweight Three-Factor Remote User Authentication Protocol for Future IoT Applications

With the booming integration of IoT technology in our daily life applications such as smart industrial, smart city, smart home, smart grid, and healthcare, it is essential to ensure the security and privacy challenges of these systems. Furthermore, time-critical IoT applications in healthcare require access from external parties (users) to their real-time private information via wireless communication devices. Therefore, challenges such as user authentication must be addressed in IoT wireless sensor networks (WSNs). In this paper, we propose a secure and lightweight three-factor (3FA) user authentication protocol based on feature extraction of user biometrics for future IoT WSN applications. The proposed protocol is based on the hash and XOR operations, including (i) a 3-factor authentication (i.e., smart device, biometrics, and user password); (ii) shared session key; (iii) mutual authentication; and (iv) key freshness. We demonstrate the proposed protocol’s security using the widely accepted Burrows–Abadi–Needham (BAN) logic, Automated Validation of Internet Security Protocols and Applications (AVISPA) simulation tool, and the informal security analysis that demonstrates its other features. In addition, our simulations prove that the proposed protocol is superior to the existing related authentication protocols, in terms of security and functionality features, along with communication and computation overheads. Moreover, the proposed protocol can be utilized efficiently in most of IoT’s WSN applications, such as wireless healthcare sensor networks