Application of artificial neural networks for the prediction of Gaza wastewater treatment plant performance-Gaza strip

This paper is concerned with the use of artificial neural network and multiple linear regression (MLR) models for the prediction of three major water quality parameters in the Gaza wastewater treatment plant. The data sets used in this study consist of nine years and collected from Gaza wastewater treatment plant during monthly records. Treatment efficiency of the plant was determined by taking into account of influent input values of pH, temperature (T), biological oxygen demand (BOD), chemical oxygen demand (COD) and total dissolved solids (TSS) with effluent output values of BOD, COD and TSS. Performance of the model was compared via the parameters of root mean squared error (RMSE), mean absolute percentage error (MAPE) and correlation coefficient (r). The suitable architecture of the neural network model is determined after several trial and error steps. Results showed that the artificial neural network (ANN) performance model was better than the MLR model. It was found that the ANN model could be employed successfully in estimating the BOD, COD and TSS in the outlet of Gaza wastewater treatment plant. Moreover, sensitive examination results showed that influent TSS and T parameters have more effect on BOD, COD and TSS predicting to other parameters

ETIOLOGY, INVESTIGATIONS, AND TREATMENT IN CASES OF CONSTRICTIVE PERICARDITIS

The fibroelastic sac that covers the heart is known as the pericardium. It has an effect on cardiac hemodynamics and serves as a protective barrier. Constrictive pericarditis is a condition in which the pericardium grows granulation tissue, causing a loss of pericardial elasticity and ventricular filling limitation. Although it is usually a chronic condition, subacute, transient, and occult variants have been reported. The pathogenesis, symptoms, and diagnosis of constrictive pericarditis, as well as the role of the interprofessional team in its treatment, are covered in this exercise. This review article aims to describe the pathophysiology of constrictive pericarditis, review a patient's presentation with constrictive pericarditis, summarise constrictive pericarditis options for treatment, and discuss the importance of improving care coordination among interprofessional team members to enhance constrictive pericarditis patient outcomes. The 10-year survival rate for patients who get a pericardiectomy is around 50%. Medical treatment alone results in a short lifespan

PATHOPHYSIOLOGY, INVESTIGATIONS, AND MANAGEMENT OF UNSTABLE ANGINA: A REVIEW

Unstable angina pectoris is a phenomenon that disrupts the early recovery phase of acute myocardial infection, the emergence of new ischemic symptoms, the development of more severe pain, usually at rest, or the formation of intermittent ischemic events. ۔ Acute myocardial infarction is the most serious complication of unstable angina pectoris, which can affect up to 25% of patients within three months of the onset of symptoms. Physically, changes in ECG and hemodynamics usually occur before the onset of pain. The following hemodynamic changes and an increase in oxygen demand in the already ischemic heart respond positively, leading to further instability in unstable angina. Hemodynamic changes may be the result of abnormal stress response or excessive chemotherapeutic discharge. While coronary spasm may play a role in the pathogenesis of unstable angina, other factors such as bleeding in the wall of the atherosclerotic plaque, peripheral embolization, alteration, or platelet aggregation in the coronary artery from nearby soft cholesterol "abscess". Feedback should also be considered. Along with medications such as nitrates, calcium antagonists, and warnings, beta-adrenergic blockers are used to stimulate coronary and peripheral vasodilation and reduce cardiac effort. Treatment with aortic counter-pulsating balloons is recommended for those who have failed to respond to pharmacological treatment. Emergency surgery should be performed voluntarily. The full clinical and pathological compatibility of unstable angina pectoris is still unknown. Future issues will revolve around further investigations into entity procedures, treatment and prevention. The purpose of this review is to explain the pathophysiology of unstable angina, highlight changes in ECG in the assessment of unstable angina, and improve the outcome of patients with unstable angina. Consider the need to strengthen the coordination of care within the team

PATHOPHYSIOLOGY, INVESTIGATIONS, AND TREATMENT OF PATIENTS WITH BICUSPID AORTIC VALVE

Bicuspid aortic valve is a congenital anomaly of the heart in which the aortic valve has two loops instead of the normal three. It causes valve degeneration and is associated with dilation of the aorta. This exercise discusses the role of inter-professional team in improving the management of patients with bicuspid aortic valves and describes the diagnosis and management of this problem. The purpose of this review article is to describe the epidemiology of bicuspid aortic valve, describe the presentation of patients with bicuspid aortic valve, summarize the use of electrocardiogram and echocardiogram in bicuspid aortic valve evaluation, and explain the importance of collaboration and communication. Interprofessional team to improve care coordination for patients with bicuspid aortic valve

A REVIEW ON MITRAL REGURGITATION: PATHOPHYSIOLOGY, INVESTIGATIONS AND TREATMENT

Background: The retrograde movement of blood from the left ventricle (LV) into the left atrium (LA) through the mitral valve (MV) causes a systolic murmur heard best at the apex of the heart with radiation to the left axilla. MR is the most common valvular anomaly in the globe, affecting around 2% of the population and increasing in incidence with age. This activity examines the diagnosis and treatment of mitral regurgitation, emphasizing the importance of the healthcare team in assessing and treating patients with this illness. Conclusion: The goal of this review article is to identify the etiology and epidemiology of mitral regurgitation medical conditions and emergencies, review the proper history, physical, and evaluation of mitral regurgitation, outline the treatment and management options for mitral regurgitation, and describe interprofessional team strategies for improving care coordination and communication to advance mitral regurgitation and improve outcomes

Is muscle activation diverse in females with isolated patellofemoral osteoarthritis contrasted with age-matched healthy controls during stair descent task?

Background: Patellofemoral osteoarthritis (PF OA) is exceptionally predominant and limiting. However, little is known about the risk factors that contribute to its onset and progression.Purpose: The aim of this study was to decide if women with PF OA descend stairs using different muscular activation strategies compared to similarly aged healthy controls.Methods: Thirty-one women with isolated PF OA and 11 similarly aged healthy women took part in this study. The activation onset and duration of PF OA in vastus medialis oblique (VMO), vastus lateralis (VL), gluteus medius (GM), transversus abdominis (TrA), and multifidus muscles were evaluated during the stair descent task using surface electromyography (EMG).Results: There was a non-significant difference between women with PF OA and healthy controls regarding all tested variables, except for the GM activation onset that was significantly delayed in women with PF OA, with the p-value of 0.011.Conclusion: The causes of PF OA differ and might not always be due to a lack of quadriceps strength or VMO activation deficiency, and prospective longitudinal studies are required to confirm this assumption

Molecular and neurological characterizations of three Saudi families with lipoid proteinosis

<p>Abstract</p> <p>Background</p> <p>Lipoid proteinosis is a rare autosomal recessive disease characterized by cutaneous and mucosal lesions and hoarseness appearing in early childhood. It is caused by homozygous or compound heterozygous mutations in the <it>ECM1 </it>gene. The disease is largely uncharacterized in Arab population and the mutation(s) spectrum in the Arab population is largely unknown. We report the neurologic and neuroradiologic characteristics and <it>ECM1 </it>gene mutations of seven individuals with lipoid proteinosis (LP) from three unrelated consanguineous families.</p> <p>Methods</p> <p>Clinical, neurologic, and neuro-ophthalmologic examinations; skin histopathology; brain CT and MRI; and sequencing of the full<it>ECM1 </it>gene.</p> <p>Results</p> <p>All seven affected individuals had skin scarring and hoarseness from early childhood. The two children in Family 1 had worse skin involvement and worse hoarseness than affected children of Families 2 and 3. Both children in Family 1 were modestly mentally retarded, and one had typical calcifications of the amygdalae on CT scan. Affected individuals in Families 2 and 3 had no grossneurologic, neurodevelopmental, or neuroimaging abnormalities. Skin histopathology was compatible with LP in all three families. Sequencing the full coding region of <it>ECM1 </it>gene revealed two novel mutationsin Family 1 (c.1300-1301delAA) and Family 2 (p.Cys269Tyr) and in Family 3 a previously described 1163 bp deletion starting 34 bp into intron 8.</p> <p>Conclusions</p> <p>These individuals illustrate the neurologic spectrum of LP, including variable mental retardation, personality changes, and mesial temporal calcificationand imply that significant neurologic involvement may be somewhat less common than previously thought. The cause of neurologic abnormalities was not clear from either neuroimaging or from what is known about <it>ECM1 </it>function. The severity of dermatologic abnormalities and hoarseness generally correlated with neurologic abnormalities, with Family 1 being somewhat more affected in all spheres than the other two families. Nevertheless, phenotype-genotype correlation was not obvious, possibly because of difficulty quantifying the neurologic phenotype and because of genetic complexity.</p

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030