Gender Differences in Presentation, Management, and In-Hospital Outcomes for Patients with AMI in a Lower-Middle Income Country: Evidence from Egypt

BACKGROUND: Many studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI). However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men. METHODS AND FINDINGS: Using registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males) with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ(2) tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation. We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01) or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively), although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87), this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55). CONCLUSIONS: We found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but highlight differences in quality of care and represent important opportunities for improvement

Understanding the Emergent Structure of Competency Centers in Post-implementation Enterprise Systems

Part 3: Structures and NetworksInternational audiencePrior research provides conflicting insights about the link between investment in enterprise systems and firm value and in the ES governance mechanisms. The literature generally suggests that management should cultivate its technical and organizational expertise to derive value from currently deployed Enterprise Systems (ES) [8]. In the realm of practice, ERP vendors and configuration/integration partners strongly recommend the creation of an organizational structure to govern the ERP implementation and post-implementation process to improve project success and extract greater value from the ES investment. The ES literature, while unclear on the formation, and functioning of ES governance units, suggests the need for formal and fixed governance structures. This research utilizes Deleuze’s assemblage theory and emergence theory to explain the genesis and evolution of the governing ‘structure’ known as the Competency Center (CC). Our results illustrate the business needs driving the structuring processes behind the CC, are also those that lead to unintended and destabilizing outcomes. Whether the CC ‘assemblage’ survives to provide value depends on how the emergent issues are handled and how the assemblages are “positioned”. This research suggests effective ES governance is not derived from a prescribed step-wise process yielding formal structures, but rather form an organic process of assemblage

A decomposition Algorithm for Solving Stochastic Multi-Level Large Scale Quadratic Programming Problem

We present a decomposition algorithm to solve a multi-level large scale quadratic programming problem with stochastic parameters in the objective functions. In the first phase of the solution algorithm and to avoid the complexity of this problem, the stochastic nature of the problem is converted into the equivalent crisp problem. In the second phase, Taylor series is combined with a decomposition algorithm to obtain the optimal solution for this problem. An illustrative example is discussed to demonstrate the correctness of the proposed solution method

Some Thiocyanate Compounds of Tin

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Individual dinoflagellate cysts species of surface sediment samples from the Mediterranean Sea

To determine the relationship between the spatial dinoflagellate cyst distribution and oceanic environmental conditions, 34 surface sediments from the Eastern and Western Mediterranean Sea have been investigated for their dinoflagellate cyst content. Multivariate ordination analyses identified sea-surface temperature, chlorophyll-a , nitrate concentration, salinity, and bottom oxygen concentration as the main factors affecting dinoflagellate cyst distribution in the region. Based on the relative abundance data, two associations can be distinguished that can be linked with major oceanographic settings. (1) An offshore eastern Mediterranean regime where surface sediments are characterized by oligotrophic, warm, saline surface water, and high oxygen bottom water concentrations (Impagidinium species, Nematosphaeropsis labyrinthus, Pyxidinopsis reticulata and Operculodinium israelianum). Based on the absolute abundance, temperature is positively related to the cyst accumulation of Operculodinium israelianum. Temperature does not form a causal factor influencing the accumulation rate of the other species in this association. Impagidinium species and Nematosphaeropsis labyrinthus show a positive relationship between cyst accumulation and nitrate availability in the upper waters. (2) Species of association 2 have highest relative abundances in the Western Mediterranean Sea, Strait of Sicily/NW Ionian Sea, and/or the distal ends of the Po/Nile/Rhône River plumes. At these stations, surface waters are characterized by (relative to the other regime) higher productivity associated with lower sea-surface temperature, salinity, and lower bottom water oxygen concentrations (Selenopemphix nephroides, Echinidinium spp., Selenopemphix quanta, Quinquecuspis concreta, Brigantedinium spp. and Lingulodinium machaerophorum). Based on both the absolute and relative abundances, Selenopemphix nephroides is suggested to be a suitable indicator to trace changes in the trophic state of the upper waters. The distribution of Lingulodinium machaerophorum is related to the presence of river-influenced surface waters, notably the Nile River. We suggest that this species might form a suitable marker to trace past variations in river discharge, notably from the Nile

Late Cretaceous Palynology and Paleoenvironment of the Razzak-3 Well, North Western Desert, Egypt

Palynological analysis of the Bahariya and Abu Roash Formations from the Razzak-3 (RZ-3) well, North Western Desert, Egypt, has yielded rich and very-well-diversified spores, pollen and dinoflagellate cysts which allow subdividing the studied rock units into four pollen/spore (PS) zones and three dinoflagellate cyst (D) zones. Miospores are abundant in the Cenomanian, while dinoflagellates predominate the Turonian-Santonian. A barren interzone delineates the oceanic anoxic event 2 and embraces member “F” of the Abu Roash Formation. The marine/nonmarine palynomorph ratio in the studied samples indicate that the Bahariya Formation was deposited in a nearshore paleoenvironment affected by continental sources with an arid to semiarid hinterland having local or seasonal humid conditions. Deposition of the Abu Roash Formation took place in the transitional zone between the inner and outer shelf. Dinoflagellate cysts in this study are of the Tethyan Realm

Comparative Study Between Double Plating and Y Plate in Management of Intercondylar Humeral Fracture

Background: Intercondylar humeral fracture is one of the commonest &amp; challenging fractures of young adult and counts for about 30% of all elbow fractures. Aim: Evaluation of two groups of patients, group 1 and group 2 managed by double plates and group B by Y plate Materials and Methods: This Prospective study was conducted on 44 patients, Group 1 22 patient and Group 2 22 patient. The study included patients aged between 16-59 years with intercondylar humeral fracture type C according to AO classification while patients with compound fractures, osteoporotic bone, pathological fractures, and patients aging less than 16 years and more than 59 years were excluded. &nbsp;Follow up at 3 and 6 months. Results: Range of movement after 3 &amp; 6 months was 84±31 and 98±35 respectively in group 1 which was relatively high compared to 48±25 and 71±21 respectively in group 2. MAYO Elbow Performance Score after 3 &amp; 6 months was 71±21 and 82±23 respectively in group 1 which was relatively high compared to 48±14 and 73±12 respectively in group 2.&nbsp

A comparative study of insulin resistance for Saudi and Caucasian subjects across a range of glycaemic categories

Aim: Saudi and Caucasian subjects, matched for adiposity, and of differing glycaemic status were compared using several insulin sensitivity indices and to also to assess insulin, glucose and insulin-like growth factor binding protein-1 (IGFBP-1) responses to intravenous glucose. Methods: Subjects with normal glucose tolerance (NGT; n = 24), impaired fasting glucose (IFG; n = 12), impaired glucose tolerance (IGT; n = 12), and type 2 diabetes (DM; n = 13) were recruited from Saudi (n = 33) and Caucasian (n = 28) populations. All had specimens taken in the context of a standard oral glucose tolerance test at their first visit and had the insulin sensitivity parameter (Si) determined by frequently-sampled intravenous glucose tolerance test (FSIVGTT) at a second visit. Results: Saudis in the NGT and pooled glucose intolerance categories had significantly higher diastolic blood pressure (p < 0.001, p < 0.05 respectively) and HbA1c (p < 0.01, p < 0.05 respectively) compared to Caucasians. Caucasians in the NGT category had significantly higher Si, fasting and 2 h IGFBP-1 (p < 0.01, p < 0.05 and p < 0.01 respectively) compared to Saudis. Two hours following oral or intravenous glucose serum IGFBP-1 decreased to 44% (p < 0.001) and 50% (p < 0.05) of baseline levels respectively. Conclusions: Our data suggest that adult Saudis with normal glucose tolerance appear to be more insulin resistant than Caucasians matched for adiposity. In normal individuals at 2 h the IGFBP-1 level will be about half the baseline level regardless of the route of glucose administration. © 2009 Diabetes India