Evaluating the independent impact of renal function decline on coronary artery calcification in patients undergone cardiac ct scan

Background: Cardiovascular events are the leading global cause of death. Calcification of coronary arteries is a common complication of renal failure and the leading cause of death in this population. However, its multifactorial mechanism is not fully understood. Objectives: The current study aimed to, firstly, investigate the association between renal dysfunction and the calcification of coronary arteries in patients with severe and milder stages of renal failure and, secondly, to determine the role of this variable by eliminating the effect of established confounding factors. Methods: Following a retrospective design, 261 patients with cardiovascular risk factors or atypical symptoms were investigated. Estimated GFR (glomerular filtration rate) was calculated using both Cockcroft-Gault and MDRD equations. An ECG-gated multidetector CT scan was performed to calculate CACS (coronary artery calcification score) using the Agatston method. The presence of significant CAC (coronary artery calcification) was defined as CACS > 100. Univariate and multivariate analyses were performed using binary logistic regression. Results: A total of 134 cases were diagnosed with CAC, and the mean CACS was 83.4 ± 18. According to univariate analysis, older age, male gender, systolic and diastolic blood pressure, and higher TG levels were correlated with the degree of CAC. HbA1C showed a weak correlation with CACS (P-value = 0.04). Renal insufficiency resulted in increased CAC, and lower eGFR (calculated with both Cockgraft-Gault and MDRD equations) was associated with higher calcification (P-value < 0.01). Our analysis shows that serum Ca, P, LDL, and HDL levels do not have a significant influence on calcification changes. After adjusting for confounding factors, male sex, age, triglyceride level, and eGFR were recognized as independent risk factors for CACS � 100, a marker of coronary artery atherosclerosis. However, HbA1C and systolic and diastolic blood pressure were no longer considered as factors that contribute to the risk of CAC. Conclusions: We observed a gradual and independent association between lower eGFR and higher CAC scores. © 2021, Author(s)

Duct-to-mucosa pancreatojejunostomy is a safe technique of reconstruction after pancreatoduodenectomy

Background: A duct-to-mucosa pancreatojejunostomy is technically difficult to perform than Dunking procedure after pancreatoduodenectomy. In contrast, the incidence of anastomotic dehiscence is more in Dunking than duct-to-mucosa procedure. Duct-to-mucosa technique is rarely practiced in our country because of technical difficulties and lack of experiences. Objectives: This study was undertaken to evaluate the safety of duct-to-mucosa procedure in our patients with pancreatoduodenectomy. Methods: We have performed pancreatojejunostomy in 14 consecutive patients using a duct-to-mucosa technique and the result was assessed. Results: No patients developed pancreato-jejunal leakage; however, 6 of 14 patients developed complications not related to operative techniques (wound infections; 3,jejunal fistula following removal of jejunal feeding tube; 1, renal dysfunction; 1, delayed gastric emptying; 1) which were managed conservatively. There were no postoperative deaths in the present series and the median postoperative hospital stay was 20.3 days. The follow-up period ranged from 1 to 12 months and all patients are surviving with good health during this period. Conclusion: Pancreatojejunostomy by duct-to-mucosal technique is a safe method of pancreatojejunostomy after pancreatoduodenecytomy

Acceptability of Massage with Skin Barrier-enhancing Emollients in Young Neonates in Bangladesh

Oil massage of newborns has been practised for generations in the Indian sub-continent; however, oils may vary from potentially beneficial, e.g. sunflower seed oil, to potentially toxic, e.g. mustard oil. The study was carried out to gain insights into oil-massage practices and acceptability of skin barrier-enhancing emollients in young, preterm Bangladeshi neonates. Preterm infants of <33 weeks gestational age were randomized to high-linoleate sunflower seed oil, Aquaphor Original Emollient Ointment™, or the comparison group (usual care). A survey was administered at admission to assess routine skin-care practices prior to admission and at discharge to assess acceptability of emollient therapy during hospitalization. Oil massage was given to 83 (21%) of 405 babies before hospital admission, 86% (71/83) of whom were delivered at home. Application of oil, most commonly mustard oil (88%, 73/83), was started within one hour of birth in 51 cases (61%) and was applied all over the body (89%, 74/83) one to six (mean 2.2) times before admission. Of infants who received emollient therapy in the hospital, 42% (n=32) of mothers reported that the emollient applied in the hospital was better than that available at home, and only 29% would use the same oil (i.e. mustard oil) in the future as used previously at home. No problems resulted from use of emollient in the hospital. Topical therapy with sunflower seed oil or Aquaphor was perceived by many families to be superior to mustard oil. If caregivers and health professionals can be motivated to use inexpensive, available emollients, such as sunflower seed oil that are beneficial, emollient therapy could have substantial public-health benefit

Determining Gestational Age in a Low-resource Setting: Validity of Last Menstrual Period

The validity of three methods (last menstrual period [LPM], Ballard and Dubowitz scores) for assessment of gestational age for premature infants in a low-resource setting was assessed, using antenatal ultrasound as the gold standard. It was hypothesized that LMP and other methods would perform similarly in determining postnatal gestational age. Concordance analysis was applied to data on 355 neonates of <33 weeks gestational age enrolled in a topical skin-therapy trial in a tertiary-care children's hospital in Bangladesh. The concordance coefficient for LMP, Ballard, and Dubowitz was 0.878, 0.914, and 0.886 respectively. LMP and Ballard underestimated gestational age by one day (±11) and 2.9 days (±7.8) respectively while Dubowitz overestimated gestational age by 3.9 days (±7.1) compared to ultrasound finding. LMP in a low-resource setting was a more reliable measure of gestational age than previously thought for estimation of postnatal gestational age of preterm infants. Ballard and Dubowitz scores are slightly more reliable but require more technical skills to perform. Additional prospective trials are warranted to examine LMP against antenatal ultrasound for primary assessment of neonatal gestational age in other low-resource settings

Acceptability of Massage with Skin Barrier-enhancing Emollients in Young Neonates in Bangladesh

Oil massage of newborns has been practised for generations in the Indian sub-continent; however, oils may vary from potentially beneficial, e.g. sunflower seed oil, to potentially toxic, e.g. mustard oil. The study was carried out to gain insights into oil-massage practices and acceptability of skin barrier-enhancing emollients in young, preterm Bangladeshi neonates. Preterm infants of &lt;33 weeks gestational age were randomized to high-linoleate sunflower seed oil, Aquaphor Original Emollient Ointment\u2122, or the comparison group (usual care). A survey was administered at admission to assess routine skin-care practices prior to admission and at discharge to assess acceptability of emollient therapy during hospitalization. Oil massage was given to 83 (21%) of 405 babies before hospital admission, 86% (71/83) of whom were delivered at home. Application of oil, most commonly mustard oil (88%, 73/83), was started within one hour of birth in 51 cases (61%) and was applied all over the body (89%, 74/83) one to six (mean 2.2) times before admission. Of infants who received emollient therapy in the hospital, 42% (n=32) of mothers reported that the emollient applied in the hospital was better than that available at home, and only 29% would use the same oil (i.e. mustard oil) in the future as used previously at home. No problems resulted from use of emollient in the hospital. Topical therapy with sunflower seed oil or Aquaphor was perceived by many families to be superior to mustard oil. If caregivers and health professionals can be motivated to use inexpensive, available emollients, such as sunflower seed oil that are beneficial, emollient therapy could have substantial public-health benefit

Produkcja wzbogaconej cynkiem biomasy Saccharomyces cerevisiae

Zinc accumulation and the growth of Saccharomyces cerevisiae were investigated in a culture with zinc sulfate-supplemented medium. The cultivations were performed on Sabouraud dextrose broth medium in aerobic conditions, without the addition of zinc (control culture) and with the addition of zinc sulfate (5, 10, 15, 30 and 60 mg ZnSO l -1 medium) at 28 ° C for 72 hours. The results showed similar trends of yeast growth rates at 24, 48, and 72-hour interval, with concentrations above 10 mg l -1 ZnSO in the nutritional medium significantly decreasing the yeast growth rate and the biomass yield ( P <0.05). Substantial differences between the initial ZnSO concentrations in the growth medium were demonstrated in the overall adsorption of Zn ions (Zn 2+ ) in yeast cells by a colorimetric assay ( P <0.05). Similarly, the content of total accumulated zinc, as well as the fractions of Zn present in cells depended mainly on the zinc concentration in the medium, as the total Zn accumulation and organically bound Zn fractions were increased by elevating the ZnSO supplementation in the culture medium up to 30 mg l -1 , but gradually reduced by any further addition of ZnSO determined by an ICP-MASS assay ( P <0.05). In the presence of 30 mg l -1 ZnSO , the Zn content in the biomass increased by 24-fold, to 4132.34 m g g -1 in comparison to 171.9 m g g -1 achieved in the basal medium. Thus, the ability of S. cerevisiae to accumulate zinc can be used for production of a zinc-rich ingredient for functional food products

Efficiency factors in OECD banks: A ten-year analysis

This paper presents a performance assessment of 128 banks from 23 OECD countries from 2004 to 2013, using different financial criteria that emulate the CAMELS rating system. A robust TOPSIS approach for assessing bank efficiency is also developed and presented. First, alternative variable reduction techniques are employed to extract the major factors within each CAMELS criterion. This is done to mitigate collinearity issues. Then, TOPSIS is used to measure bank performance based upon these factors, equally weighted. A comprehensive analysis based on a weighted linear optimization model for multi-criteria classification is also performed, which detects any discrepancies from the original scores. Lastly, censored quantile regressions are combined with bootstrapped TOPSIS scores to produce a model for predicting the impact of different contextual variables on different efficiency quantiles. Results reveal that the effects of ownership, trend, and origin of the bank may vary with respect to efficiency levels, whether high or low

The proposal and application of a 2-Dimensional Fuzzy Monte Carlo Frontier analysis for estimating Islamic bank efficiency

YesThe current study proposes a novel 2-Dimensional Fuzzy Monte-Carlo Frontier Analysis to estimate and compare the level of efficiency for a sample of 49 Islamic Banks across 25 countries worldwide over the period 2013-2021. Additionally, in the second stage, we propose a bootstrapped robust regression approach to comprehensively examine the determinants of efficiency. Our results show that there is heterogeneity in the level of efficiency within the Islamic banking sector. Furthermore, we find that the Islamic banks in the sample experienced an improvement in efficiency over the examined period. Finally, we find that bank size, bank liquidity (measured by the ratio between net loans and gross loans), and bank risk (proxied by the ratio between loan loss reserves and gross loans) have a significant and positive impact on Islamic bank efficiency. Policy implications based on our findings are provided.The full-text of this article will be released for public view at the end of the publisher embargo - 12 months after publication

Efficiency analysis of major microfinance institutions in Bangladesh: a Malmquist index approach

Microfinance institutions (MFIs) have dual objectives- reaching under privileged households for poverty easing and achieving financial sustainability. This paper investigates the efficiency of major 15 MFIs in Bangladesh using Malmquist index (MI) over the period 2008–2012. A balanced panel dataset of 75 observations is used. The results from MI are decomposed into three efficiency scores—technical efficiency (TCH), scale efficiency (SE) and pure efficiency (PE). The empirical findings indicate that MFIs are experienced an excellent annual efficiency progress (93.5 %) which was mainly because of PE. PE measures the capacity of optimizing minimum input to produce maximum output by reducing production wastage. This outstanding growth was an outcome of country’s ever best economic settings before 2008. However, from 2009 onward, a substantial efficiency regresses is observed. The results also signify that the major MFIs have less capacity to work at their optimal scales. The contribution of SE is very low (only 2.2 %) compared to total efficiency progress. Findings from TCH indicate that the overall frontier is moving relatively slow in an outward direction (only 3.7 % of TCH progress)

Do African microfinance institutions need efficiency for financial stability and social outreach?

Microfinance institutions (MFIs) have the dual objective of providing social welfare and financial stability. We evaluated the financial efficiency of MFIs in sub-Saharan African countries by comparing their regional performances during the period 2004'2013. We addressed prevailing MFI heterogeneity by using the concept of 'metafrontier'. The results showed that on an average, more than half the MFIs showed a drop in productivity. The measure of how much one country gets closer to or further away from world frontier technology is commonly known as the TGC score. In world frontier technology, East and South Asian countries have taken the lead (TGC score 1.0048) while sub-Saharan African countries lag behind (TGC score 1.0020). Most East and South Asian countries have a TGC score of 1, and most sub-Saharan African countries have a TGC score less than 1. This signifies that Asian countries lead world frontier technology and most African countries do not. The decomposition of efficiency scores showed that with regard to technical changes, African nations had progressed on average only 0.01%, and efficiency change scores had regressed by 0.59% annually. Significance: • First efficiency study on microfinance institutions and their heterogeneity in Africa. • The results show robust discrimination among the efficiency scores