Acute effects of cigarette smoking on the cardiac diastolic functions

AbstractBackgroundSmoking is an independent risk factor for coronary heart diseases and it increases all causes of cardiovascular morbidity and mortality.Aim of the workTo assess the acute effect of cigarette smoking on ventricular diastolic functions (LV and RV) in healthy, young, and slim smokers.MethodsThirty volunteers who had recently commenced smoking (less than one year) and who smoked 1–2 cigarettes per day, underwent ECG, 2D and M-mode echocardiography, standard Doppler echocardiography, pulsed TDI (tissue Doppler imaging) on septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were measured. The investigator asked them to hold smoking for at least two days after which echocardiographic examination was conducted before smoking one cigarette and the second examination conducted immediately after smoking one cigarette containing at least 0.4mg of nicotine.ResultsDoppler findings over the mitral valve showed the E wave was significantly reduced from 82.7±10.4 to 74.6±10.4 after smoking; the A wave increased; the E/A ratio was reduced from 1.5±0.3 to 1.2±0.2; the E′ septal significantly decreased (15.3±2.4 vs. 11.2±1.1) after smoking, and the E/E′ ratio increased from 5.5±1.1 to 6.7±1.1. Doppler findings over the tricuspid valve showed the E wave was reduced from 60.6±9.7 to 52.7±9.6; the A wave increased from 42.2±6.5 to 50.1±6.6; and the E/A ratio decreased (1.45±0.25 vs. 1.06±0.19). The E′ significantly decreased from 14.1±1.8 to 10.9±2.4, while the A′ increased (10.2±2.4 vs. 12.7±3.6) after smoking; and the IVRT of the RV was significantly prolonged from 62.9±7.5 to 68.7±7.9 after smoking. The Vp was markedly reduced from 67.8±8 to 55.2±3.5 after smoking. These findings reflected on the LV filling pressure (LVFvp) which increased from 9.8±1.4 to 10.5±1.3 after smoking. All changes were statistically significant at P<0.001.ConclusionsOur study reveals that cigarette smoking can result in significant acute alteration in the diastolic functions of both ventricles

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

Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients

Background Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease with probable autoimmune aetiology. RA has many secondary complications and a variety of neuropsychological consequences. Aim The aim of this study was to estimate the frequencies of neuropsychiatric disorders in RA patients and their relationship with the duration and activity of disease. Patients and methods Seventy-four consecutive female RA patients were recruited and compared with 25 age-matched and education status-matched female healthy volunteers. All eligible participants underwent clinical, laboratory and electrophysiological examinations (motor and sensory nerve conduction study, F-wave of four limbs, P300 event-related potential and electroencephalography). The Structured Clinical Interview for Diagnostic and statistical manual of mental disorders, 3rd ed., Revised (DSM-III-R) Axis I Disorders (SCID-I) for diagnosis of psychiatric illness and the Wechsler Adult Intelligence Scale, 3rd ed. (WAIS-III) with assessment of total scale, verbal and performance intelligence quotients (IQ) were administered to all participants. Results Fourteen (18.9%) patients had evidence of symptomatic peripheral neuropathy and radiculopathy, whereas 60.8% had psychiatric disorders. Depression was the most prevalent psychiatric disorder (45%), followed by anxiety (27%) and comorbid anxiety with depression (21.6%). Low IQ scores were recorded in 54% of patients. P300 latency was significantly prolonged (P = 0.0001), and seven (9.5%) RA patients recorded abnormal P300 latency (>mean ± 2 SD) compared with control values. Abnormal electroencephalography findings were observed in 48.6%. Visual analogue scale pain score was significantly higher among patients with psychiatric disorders versus patients without psychiatric disorders (P = 0.0001). Significant negative correlation was recorded between Disease Activity Score and total IQ score (P = 0.01), whereas no significant association was seen between Disease Activity Score and the presence of neuropathy or psychiatric disorders. Conclusion Cognitive impairment, depression, anxiety and peripheral neuropathy are common in RA patients. Early diagnosis and management of neuropsychiatric disorders in RA patients may greatly improve the patients′ health-related quality of life

Environmental Streptococcus uberis Associated with Clinical Mastitis in Dairy Cows: Virulence Traits, Antimicrobial and Biocide Resistance, and Epidemiological Typing

Mastitis remains a serious problem for dairy animals. The misappropriation of antimicrobial agents helps accelerate resistance, which poses a serious challenge in controlling environmental S. uberis infection. Here, we study the virulence attributes, antimicrobial and biocide resistance, and epidemiological typing of S. uberis recovered from bovine clinical mastitis in dairy farms of diverse hygienic interventions in Egypt. The overall S. uberis infection rate was 20.59%; all were multidrug-resistant (MDR). The sua gene was the most frequent virulence gene (42.02%), followed by pauA (40.57%), cfu (21.73%), skc (20.28%), and opp (11.59%). The erm(B) gene served as the predominant antimicrobial-resistant gene (75.36%), followed by fexA (52.63%) and tet(M), blaZ, and aac(6′)aph(2″) genes (46.38% each). Of note, 79.71%, 78.26%, and 18.84% of S. uberis isolates harbored qacED1, qacC/D, and qacA/B genes, respectively. All analyzed isolates were S. uberis type I by their unique RFLP–PCR pattern. In conclusion, the sustained presence of pauA and sua genes throughout the investigated farms contributes to a better understanding of the bacterium’s pathogenicity. Furthermore, MDR coupled with the existence of biocide resistance genes indicates the importance of S. uberis surveillance and the prudent use of antimicrobials in veterinary clinical medicine to avoid the dissemination of antimicrobial resistance

The Role of Pancreatic Stone Protein in Diagnosis of Early Onset Neonatal Sepsis

Introduction. Early diagnosis and treatment of neonatal sepsis may help decrease neonatal mortality. Aim of the Study. To evaluate the role of pancreatic stone protein as a marker for early onset neonatal sepsis. Methods. A hospital-based prospective study was conducted on 104 (52 uninfected and 52 infected neonates) admitted to the Neonatal Intensive Care Unit (NICU) of Zagazig University hospitals during the period from April 2014 to April 2015. All newborns were subjected to full history taking, careful neonatal assessment, blood, C-reactive protein (CRP), and serum pancreatic stone protein. Results. Serum PSP levels were significantly higher in the infected group than in the uninfected group. At a cutoff level of PSP 12.96 ng/mL, the sensitivity was 96.2%, the specificity was 88.5%, positive predictive value was 95.8%, negative predictive value was 89.3%, and area under the curve was 0.87. A significant positive correlation between CRP and PSP was found in infected group. Conclusion. The high negative predictive value of PSP (89.3%) indicates that the serum PSP level is a good marker for diagnosis of early onset neonatal sepsis and can be used to limit hospital stay and antibiotic use in neonates treated for suspected sepsis