Awareness of Basic Life Support among Egyptian Medical Students; a Cross-Sectional Study

Introduction: It is important for all medical and paramedical staff to be aware of basic life support (BLS) maneuvers. In this study, we aimed to evaluate the level of BLS awareness among Egyptian medical students.Methods: The level of BLS knowledge was assessed using a validated questionnaire and the results were analyzed using an answer key, prepared from the Advanced Cardiac Life Support (ACLS) manual. We used the Student's t-test to analyze the association between awareness level and year of study, previous BLS training and practical experience.Results: A total of 823 medical students with the mean age of 20.3 ± 2.7 years, from Al-Azhar medical schools completed the questionnaire (463 and 360 in academic and clinical years, respectively). About 72% and 84% of students failed to recognize the proper point of chest compression in adults and infants, respectively. Moreover, the majority (80%) did not know how to give rescue breathing in infants. Only 18% of students correctly identified early signs of shock and only 22% knew how to help patients with myocardial infarction. Being in clinical years, previous BLS training or practical experience were significantly associated with higher BLS knowledge scores (p < 0.001).Conclusion: The level of BLS awareness among Egyptian medical students is generally poor. Introduction of regular BLS courses into the undergraduate curriculum is a must to increase the level of BLS knowledge among Egyptian future physicians

Approaches in biotechnological applications of natural polymers

Natural polymers, such as gums and mucilage, are biocompatible, cheap, easily available and non-toxic materials of native origin. These polymers are increasingly preferred over synthetic materials for industrial applications due to their intrinsic properties, as well as they are considered alternative sources of raw materials since they present characteristics of sustainability, biodegradability and biosafety. As definition, gums and mucilages are polysaccharides or complex carbohydrates consisting of one or more monosaccharides or their derivatives linked in bewildering variety of linkages and structures. Natural gums are considered polysaccharides naturally occurring in varieties of plant seeds and exudates, tree or shrub exudates, seaweed extracts, fungi, bacteria, and animal sources. Water-soluble gums, also known as hydrocolloids, are considered exudates and are pathological products; therefore, they do not form a part of cell wall. On the other hand, mucilages are part of cell and physiological products. It is important to highlight that gums represent the largest amounts of polymer materials derived from plants. Gums have enormously large and broad applications in both food and non-food industries, being commonly used as thickening, binding, emulsifying, suspending, stabilizing agents and matrices for drug release in pharmaceutical and cosmetic industries. In the food industry, their gelling properties and the ability to mold edible films and coatings are extensively studied. The use of gums depends on the intrinsic properties that they provide, often at costs below those of synthetic polymers. For upgrading the value of gums, they are being processed into various forms, including the most recent nanomaterials, for various biotechnological applications. Thus, the main natural polymers including galactomannans, cellulose, chitin, agar, carrageenan, alginate, cashew gum, pectin and starch, in addition to the current researches about them are reviewed in this article.. }To the Conselho Nacional de Desenvolvimento Cientfíico e Tecnológico (CNPq) for fellowships (LCBBC and MGCC) and the Coordenação de Aperfeiçoamento de Pessoal de Nvíel Superior (CAPES) (PBSA). This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2013 unit, the Project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462) and COMPETE 2020 (POCI-01-0145-FEDER-006684) (JAT)

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

Contributions to advanced dynamic rotating machinery modelisation in the Arlequin framework

Les machines tournantes sont le siège de phénomènes vibratoires particuliers liés à des sources d’excitation variées dues à l’effet de rotation, au couplage vibrations/mouvements de rotation/écoulements tournants, à la symétrie périodique ou quasi-périodique des structures, et à l’amortissement interne et externe. Les travaux de recherche présentés dans ce mémoire portent sur le développement d’une méthodologie de couplage de modèles 1D poutre et 3D pour l’analyse dynamique avancée des machines tournantes. La méthode Arlequin est une méthode de raccord de modèles autorisant par l’intermédiaire d’une technique de superposition, de coupler des modèles numériques de nature différente. L’extension de cette méthode au cadre de la dynamique des machines tournantes offre la possibilité de mieux traiter les aspects énergétiques et propagation d’ondes à travers la zone de recouvrement. À cette fin, plusieurs points sont abordés. Le premier point concerne l’écriture du formalisme Arlequin en régime dynamique transitoire dans le cadre du raccord 1D-3D. À partir des formulations continue et discrétisée, les questions de couplage multi-schémas/multi-échelles en temps sont traitées en se basant sur la conservation de l’énergie globale des sous-domaines couplés. Dans le second point, une méthode de raccord multi-schémas/mono-échelle en temps fondée sur une pondération de type partition de l’unité des paramètres du schéma de Newmark dans la zone de collage est proposée. Elle permet de garantir l’équilibre énergétique du système global et assure la continuité des quantités cinématiques à l’interface. Puis cette approche est généralisée au cadre des raccords multi-schémas/multi-échelles. Ce nouveau formalisme autorise l’intégration numérique avec des schémas et des échelles de temps différents dans un contexte de raccord avec recouvrement tout en préservant l’équilibre énergétique global. Le dernier point traite deux volets principaux. Dans le premier volet, une formulation mixte ciblant les applications machines tournantes pour lesquelles un repère fixe et un autre tournant coexistent, est mise en place. Dans le second volet, le formalisme multi-schémas/multi-échelles en temps est étendu à la formulation mixte dans le but d’obtenir une approche générale permettant l’analyse de modélisations avancées de machines tournantes. La pertinence de ces travaux est illustrée par une application semi-industrielle représentant une application de type machines tournantes.Rotating machinery are subjected to specific vibratory phenomena related to various sources of excitation arising from rotation, vibration / rotation movements coupling, symmetry of the periodic or quasi-periodic structures, and internal and external damping. This work focuses on developing a methodology for coupling beam and 3D models for advanced dynamic analysis of rotating machinery. The Arlequin method is a multi-scale computation strategy allowing the coupling of numerical models of different nature through a technique of superposition. The extension of this method to the dynamics of rotating machinery framework offers the possibility of a better treatment of the energy aspects and wave propagation through the overlapping zone. To this end, several points are discussed. The first one concerns writing the Arlequin formalism in a transient dynamic regime for a 1D-3D coupling. Using the continuous and discrete formulations, questions regarding coupling different integration schemes and heterogeneous time scales are studied based on the total energy conservation of the coupled sub-domains. In the second point, a multi-scheme integration method based on a weighting partition of unity function of the Newmark’s scheme parameters in the gluing zone is proposed. It ensures the energy balance of the overall system and the continuity of kinematic quantities at the interface. This approach is then generalized to a multi-scheme / multi-scale framework. Based on displacement continuity in the recovering area, this new formalism allows the numerical integration with different time scales and heterogeneous time schemes while preserving the overall energy balance. The last point deals with two main components. In the first phase, a mixed formulation aiming at rotating machinery applications where a rotating and a fixed frame coexist is developed. In the second phase, the multi-scheme / multi-scale framework is extended and applied to the mixed formulation in order to obtain a general approach for analyzing advanced modeling of rotating machinery. The relevance of this work is illustrated by a representative application of rotating machines

Bilateral Hip Dislocation in Unrestrained Driver

History of present illness: A 24-year-old male was brought in by paramedics status post motor vehicle collision (MVC) into an electric pole and tree at high speed. The patient was an unrestrained driver who required extrication. The patient complained of left hip pain, left foot pain, and difficulty extending his bilateral lower extremities. He denied numbness or tingling to his lower extremities. The patient had normal vitals; his bilateral lower extremities were held in flexion at the hips, but otherwise had no obvious injuries. The patient’s pelvis was stable with palpable distal pulses and intact motor and sensory function of his distal lower extremities. Significant findings: The initial radiograph of the pelvis revealed bilateral hip dislocations. Small bony fragments were noted in the right hip joint, suggestive of an underlying fracture. The sacroiliac joints and the pelvic ring were intact. In the emergency department, bilateral hip reductions were performed using the Captain Morgan technique.1 The post-reduction film showed reduction of the bilateral hip dislocations with extensive comminuted and displaced fractures of the right and left acetabula. Discussion: Bilateral hip dislocations are extremely rare, occurring in only 1% of all hip dislocations,2 and require immense force, typically occurring in MVCs (74%).3-7 Associated injuries include fracture of the acetabulum or femoral head, sciatic nerve damage, and obstruction of the blood supply to the femoral head.8 X-ray imaging and CT scans are used to assess the injury and to detect intra-articular fragments.3 Definitive treatment is achieved by closed reduction if possible; otherwise open reduction is utilized.9 Post-reduction therapy includes a non-weight-bearing period of time. Complications include avascular necrosis of the femoral head, osteonecrosis, and posttraumatic arthritis, the occurrence of which can be decreased by early reduction.4,10-12 This patient underwent bilateral closed hip reductions in the ER in conjunction with orthopedic surgery and underwent operative management of his pelvic fractures at a later date

Open Book Pelvic Fracture

History of present illness: A 31-year-old male was brought in by paramedics status post high-speed motorcycle collision. The patient was tachycardic and hypotensive with an initial Glascow coma scale (GCS) of 11. He required immediate blood transfusion and intubation. The patient had multiple traumatic injuries including a deformity to the left thigh and an unstable pelvis. He had palpable distal pulses, and grossly normal sensation and motor function to his bilateral lower extremities. Significant findings: The initial radiograph of the pelvis shows an open-book pelvic fracture deformity with pubic symphyseal dislocation, left greater than right sacroiliac diastases, and fractures of the left superior and inferior pubic rami, right inferior pubic ramus, and left acetabular anterior column. The additional inlet and outlet radiographs of the pelvis after application of a pelvic binder also show an open book fracture with significant improvement of the widened pubic symphysis. Discussion: Severe pelvic injuries, including open book dislocations, have a high mortality rate of 10.4%.1,2 The mechanism is commonly a motor vehicle collision or fall from a significant height.3 Open book dislocations of the pubic symphysis are rare, representing 0.3–8.2% of all fractures,4,5 and can lead to fatal complications through vascular, abdominal, and nervous injuries.6 In severe pelvic traumas, pelvic binders must be applied as soon as possible to reduce bleeding by realigning fracture surfaces and provide stabilization of unstable fractures.7,8 Open book dislocation can be identified via plain anteroposterior pelvis radiographs.9 Definitive treatment of open book dislocations are highly individualized and come secondary to controlling hemorrhagic bleeding. The most common method is open reduction and internal fixation (ORIF) although in some cases, external fixation can be sufficient to stabilize the pelvis.10 Our patient was admitted for multiple traumatic injuries and underwent closed reduction and percutaneous fixation of posterior pelvic ring, including bilateral sacroiliac joints, and ORIF of the pubic symphysis

Open Book Pelvic Fracture

History of present illness: A 31-year-old male was brought in by paramedics status post high-speed motorcycle collision. The patient was tachycardic and hypotensive with an initial Glascow coma scale (GCS) of 11. He required immediate blood transfusion and intubation. The patient had multiple traumatic injuries including a deformity to the left thigh and an unstable pelvis. He had palpable distal pulses, and grossly normal sensation and motor function to his bilateral lower extremities. Significant findings: The initial radiograph of the pelvis shows an open-book pelvic fracture deformity with pubic symphyseal dislocation, left greater than right sacroiliac diastases, and fractures of the left superior and inferior pubic rami, right inferior pubic ramus, and left acetabular anterior column. The additional inlet and outlet radiographs of the pelvis after application of a pelvic binder also show an open book fracture with significant improvement of the widened pubic symphysis. Discussion: Severe pelvic injuries, including open book dislocations, have a high mortality rate of 10.4%.1,2 The mechanism is commonly a motor vehicle collision or fall from a significant height.3 Open book dislocations of the pubic symphysis are rare, representing 0.3–8.2% of all fractures,4,5 and can lead to fatal complications through vascular, abdominal, and nervous injuries.6 In severe pelvic traumas, pelvic binders must be applied as soon as possible to reduce bleeding by realigning fracture surfaces and provide stabilization of unstable fractures.7,8 Open book dislocation can be identified via plain anteroposterior pelvis radiographs.9 Definitive treatment of open book dislocations are highly individualized and come secondary to controlling hemorrhagic bleeding. The most common method is open reduction and internal fixation (ORIF) although in some cases, external fixation can be sufficient to stabilize the pelvis.10 Our patient was admitted for multiple traumatic injuries and underwent closed reduction and percutaneous fixation of posterior pelvic ring, including bilateral sacroiliac joints, and ORIF of the pubic symphysis

Contributions à la modélisation avancée des machines tournantes en dynamique transitoire dans le cadre Arlequin

Les machines tournantes sont le siège de phénomènes vibratoires particuliers liés à des sources d excitation variées dues à l effet de rotation, au couplage vibrations/mouvements de rotation/écoulements tournants, à la symétrie périodique ou quasi-périodique des structures, et à l amortissement interne et externe. Les travaux de recherche présentés dans ce mémoire portent sur le développement d une méthodologie de couplage de modèles 1D poutre et 3D pour l analyse dynamique avancée des machines tournantes. La méthode Arlequin est une méthode de raccord de modèles autorisant par l intermédiaire d une technique de superposition, de coupler des modèles numériques de nature différente. L extension de cette méthode au cadre de la dynamique des machines tournantes offre la possibilité de mieux traiter les aspects énergétiques et propagation d ondes à travers la zone de recouvrement. À cette fin, plusieurs points sont abordés. Le premier point concerne l écriture du formalisme Arlequin en régime dynamique transitoire dans le cadre du raccord 1D-3D. À partir des formulations continue et discrétisée, les questions de couplage multi-schémas/multi-échelles en temps sont traitées en se basant sur la conservation de l énergie globale des sous-domaines couplés. Dans le second point, une méthode de raccord multi-schémas/mono-échelle en temps fondée sur une pondération de type partition de l unité des paramètres du schéma de Newmark dans la zone de collage est proposée. Elle permet de garantir l équilibre énergétique du système global et assure la continuité des quantités cinématiques à l interface. Puis cette approche est généralisée au cadre des raccords multi-schémas/multi-échelles. Ce nouveau formalisme autorise l intégration numérique avec des schémas et des échelles de temps différents dans un contexte de raccord avec recouvrement tout en préservant l équilibre énergétique global. Le dernier point traite deux volets principaux. Dans le premier volet, une formulation mixte ciblant les applications machines tournantes pour lesquelles un repère fixe et un autre tournant coexistent, est mise en place. Dans le second volet, le formalisme multi-schémas/multi-échelles en temps est étendu à la formulation mixte dans le but d obtenir une approche générale permettant l analyse de modélisations avancées de machines tournantes. La pertinence de ces travaux est illustrée par une application semi-industrielle représentant une application de type machines tournantes.Rotating machinery are subjected to specific vibratory phenomena related to various sources of excitation arising from rotation, vibration / rotation movements coupling, symmetry of the periodic or quasi-periodic structures, and internal and external damping. This work focuses on developing a methodology for coupling beam and 3D models for advanced dynamic analysis of rotating machinery. The Arlequin method is a multi-scale computation strategy allowing the coupling of numerical models of different nature through a technique of superposition. The extension of this method to the dynamics of rotating machinery framework offers the possibility of a better treatment of the energy aspects and wave propagation through the overlapping zone. To this end, several points are discussed. The first one concerns writing the Arlequin formalism in a transient dynamic regime for a 1D-3D coupling. Using the continuous and discrete formulations, questions regarding coupling different integration schemes and heterogeneous time scales are studied based on the total energy conservation of the coupled sub-domains. In the second point, a multi-scheme integration method based on a weighting partition of unity function of the Newmark s scheme parameters in the gluing zone is proposed. It ensures the energy balance of the overall system and the continuity of kinematic quantities at the interface. This approach is then generalized to a multi-scheme / multi-scale framework. Based on displacement continuity in the recovering area, this new formalism allows the numerical integration with different time scales and heterogeneous time schemes while preserving the overall energy balance. The last point deals with two main components. In the first phase, a mixed formulation aiming at rotating machinery applications where a rotating and a fixed frame coexist is developed. In the second phase, the multi-scheme / multi-scale framework is extended and applied to the mixed formulation in order to obtain a general approach for analyzing advanced modeling of rotating machinery. The relevance of this work is illustrated by a representative application of rotating machines.VILLEURBANNE-DOC'INSA-Bib. elec. (692669901) / SudocSudocFranceF