Effect of Body Weight on Pattern of Coronary Lesions in Patients Undergoing Coronary Angiography at Sohag University Hospital

Background: Obesity is related to multiple risk factors of cardiovascular disease (CVD) including hypertension, diabetes mellitus (DM), metabolic syndrome, and dyslipidemia, while also likely being an independent risk factor for CVD. Through multiple pathways including increased angiotensin, circulating blood volume, and total peripheral resistance, excess weight increases hypertension (HTN) risk.Objective: This study aimed to reveal the relationship between body weight and the severity of coronary artery disease (CAD) in patients referred for coronary angiography at Sohag University Hospital.Patients and methods: This was a cross-sectional hospital-based study performed on 200 patients, at Sohag University Hospital. Mean age was 56.94 ± 10.30 years. Among them, there were 175 patients (87.5%) who were overweight or obese with higher prevalence of HTN, hyperlipidemia, and diabetes. Normal weight patients were 25 (12.5%) with lower prevalence of HTN, hyperlipidemia, and diabetes.Results: According to BMI in our study, 175 patients (87.5 %) were overweight or obese, 162 patients (92.57%) of the overweight had significant coronary artery disease. 162 patients (81%) had significant coronary angiography findings (> 70% stenosis in any of the coronary arteries). They were classified to 63 patients (31.5%) had single vessel diseased, 53 patients (26.5%) had two vessels diseased, and 46 patients (23%) had three vessels diseased.Conclusion: Obesity, diabetes, hypertension, hyperlipidemia, aging and male gender were correlated with severity of CAD. Thus, reduction of weight, stoppage of smoking and control of diabetes, hypertension and hyperlipidemia will improve outcome of coronary artery disease

Massive Open Online Courses (MOOCs) and their effect on learners motivation

Massive Open Online Course (MOOC) have become a new form innovation whose development has shown great challenges to the traditional classroom mode of teaching, they have also proven to be an alternative way of delivering interactive teaching as well as learning. The aim of this paper is to determine the key factors affecting student motivation in course completion as well as the approaches used by teachers to ensure that the students complete the course. To help in building a better understanding, an in-depth interview was conducted with a course facilitator at the International Islamic University. To get the students perspective on learning through MOOCS, a survey was distributed among students from several universities across Malaysia. The purpose of this survey was to probe students motivation, learning perceptions, and experiences towards MOOCS, focusing on MOOCS affordances and challenges that may lead to high dropout rates. This research paper has helped identify the learning motivations, learning styles, and a number of factors that appear to influence student motivation. © 2018 IEEE

ANALYZING THE IMPACT OF HVDC TRANSMISSION ON A DISTRIBUTION SYSTEM LOADED WITH NON LINEAR LOADS

Owing to several economic and technical benefits over AC transmission, High Voltage Direct Current Transmission (HVDC) has drawn a lot of attention in recent times. HVDC gives rise to harmonic distortion due to the power flow through power electronic inverters. The scenario gets even more critical by considering the increased influx of non linear loads in distribution systems. This research work strives to evaluate the impact of HVDC inverters on such distribution systems. The harmonic model of the inverter, developed by experimentation, is modified to decrease the harmonic distortion; which is then used for simulating a generic UK residential distribution system deploying Electrical Transient Analyzer Program. The simulation results indicate increased harmonic distortion in voltage beyond standard limits at high tension as well as low tension sides of the distribution transformer. The results also show that harmonic distortion produced by the HVDC inverters may trigger resonance at a particular harmonic frequency

Video-Assisted Mini-Thoracotomy Versus Anterior Thoracotomy Mitral Valve Replacement: Intraoperative Time and Hospitalization

Objectives: Minimally invasive mitral valve surgery (MIMVS) was introduced to avoid a full sternotomy through smaller or alternative chest wall incisions to reduce complications. We present our experience with MIMVS through two of its techniques. Methods: This prospective single-centre study was conducted on a total of 34 cases, divided into two groups: Group A (VAMVR) included 17 patients who underwent video-assisted mitral valve replacement. Group B (ATMVR) included 17 patients who underwent right anterior thoracotomy mitral valve replacement, comparing intraoperative procedures and the results of both techniques .Results: In the studied cases, the mean intraoperative time was 4.38 ± 0.69 hours, which widely ranged from 3 to 6 hours, with no significant difference between both techniques. It was 4.35 ± 0.7 hours in VAMVR and 4.41 ± 0.7 in ATMVR. mean ventilation time of 3.96 ± 1.08 hours. The mechanical ventilation time was 4.24 ± 1.1 hours in VAMVR cases and 3.68 ±1.1 hours in the ATMVR group. The mean overall ICU stay duration was 1.75 ± 0.33 days, with no impact of the technique used on this time, as it was 1.71 ± 0.25 days in VAMVR patients and 1.79 ± 0.4 in ATMVR patients. The total hospital stay time was about 5.71 ± 0.91 days, ranging from 4 to 8 days, with no impact of the procedure used on this time as it was 5.6 ± 0.94 days in VAMVR cases and 5.8 ± 0.88 days in ATMVR cases. Conclusions: There was no impact of the technique used in MIMVS, whether video-assisted or right anterior thoracotomy mitral valve replacement, on intraoperative time and ICU and hospital stays

¹H-NMR metabolic profiling, antioxidant activity, and docking study of common medicinal plant-derived honey

The purpose of this investigation was to determine ¹H-NMR profiling and antioxidant activity of the most common types of honey, namely, citrus honey (HC1) (Morcott tangerine L. and Jaffa orange L.), marjoram honey (HM1) (Origanum majorana L.), and clover honey (HT1) (Trifolium alexandrinum L.), compared to their secondary metabolites (HC2, HM2, HT2, respectively). By using a ¹H-NMR-based metabolomic technique, PCA, and PLS-DA multivariate analysis, we found that HC2, HM2, HC1, and HM1 were clustered together. However, HT1 and HT2 were quite far from these and each other. This indicated that HC1, HM1, HC2, and HM2 have similar chemical compositions, while HT1 and HT2 were unique in their chemical profiles. Antioxidation potentials were determined colorimetrically for scavenging activities against DPPH, ABTS, ORAC, 5-LOX, and metal chelating activity in all honey extract samples and their secondary metabolites. Our results revealed that HC2 and HM2 possessed more antioxidant activities than HT2 in vitro. HC2 demonstrated the highest antioxidant effect in all assays, followed by HM2 (DPPH assay: IC50 2.91, 10.7 μg/mL; ABTS assay: 431.2, 210.24 at 50 ug/mL Trolox equivalent; ORAC assay: 259.5, 234.8 at 50 ug/mL Trolox equivalent; 5-LOX screening assay/IC50: 2.293, 6.136 ug/mL; and metal chelating activity at 50 ug/mL: 73.34526%, 63.75881% inhibition). We suggest that the presence of some secondary metabolites in HC and HM, such as hesperetin, linalool, and caffeic acid, increased the antioxidant activity in citrus and marjoram compared to clover honey

Twenty five-gauge sutureless vitrectomy versus 20-gauge vitrectomy in epiretinal membrane surgery

Purpose : To compare visual outcomes, intraoperative and postoperative complications of 25-gauge transconjunctival sutureless vitrectomy (25-G TSV) versus conventional 20-gauge vitrectomy in epiretinal membrane (ERM) surgery. Methods : A retrospective comparative study was conducted on 200 eyes with idiopathic ERM who underwent either primary 20-gauge vitrectomy (n=95) or 25-G TSV (n=105) with 6 months follow up. The following parameters were collected and compared : age, gender, best corrected visual acuity (BCVA), intraocular pressure (IOP), postoperative anterior chamber inflammation, intraoperative and postoperative complications. Results : Twenty-five gauge group achieved a significantly better vision at the 1st postoperative month (p=0.008) and a significantly higher incidence of visual improvement 6 months postoperatively (p=0.04) than 20-gauge group. Intraocular pressure was significantly higher at the 1st, 3rd and 6th postoperative months compared with baseline in the 20-G group. However, in the 25-gauge group IOP remained near to the baseline at the same period. Twenty five-gauge group achieved a significantly lower anterior chamber inflammation and a lower incidence of postoperative cystoid macular edema (CME) (p=0.01), hyphema (p=0.000) and after cataract (p=0.000) than 20-gauge group. Conclusions : The 25-gauge sutureless vitrectomy achieves rapid and higher visual improvement, less postoperative inflammation and complications than the 20-gauge vitrectomy in ERM surgery

The mechanism of action of Spirulina as antidiabetic: a narrative review

Spirulina happens to be a special type of blue-green algae that originally emerged 3.5 billion years ago and was used as a source of nutrition. Spirulina gets its name from the filaments’ spiral or helical structure, but its true name is taxonomically Genus Arthrospira which encompasses several species. The most common species are S. fusiformis, S. maxima, and S. platensis. It is rich in various nutrients and chemical components including protein, carbohydrates, lipids, vitamins, minerals, pigments, chlorophyll, and enzymes. Spirulina’s active molecules and rich nutrients make it have several pharmacological activities and uses including antioxidant, anti-inflammatory, immunomodulatory, immune system booster, anticancer, antiviral activity, and neuroprotective properties. It is also utilized as a nutritional supplement and for weight loss. Moreover, several studies confirm that Spirulina improves insulin sensitivity and reduces blood glucose levels in rat models as well as diabetic patients. The reason behind this unique behavior could be credited to the presence of several active components in it, but the action’s fundamental mechanism is still a matter of debate. Several studies have suggested different mechanisms including anti-inflammatory activity, increased insulin sensitivity, inhibition of gluconeogenesis, antioxidant activity, modulating gut microbiota composition, improved glucose homeostasis, and insulin receptor activation. Therefore, it became clear that Spirulina is a mine of active substances used as a nutritional supplement and reduces blood glucose levels or used in conjunction with other treatments to tackle type 2 diabetes. Further exploration is required to fully explain its effects on human physiology and determine optimal dosages for treatment

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

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 years; 78.2% included were male with a median age of 37 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