Ascites: Causes, Diagnosis, and Treatment

Ascites is a pathological accumulation of fluid in the peritoneal cavity. Cirrhosis is the most common cause of ascites, representing for 85% of cases. More than one cause may be responsible for the development of ascites (multifactorial). Development of ascites is a poor prognostic event in the natural history of cirrhosis, with approximately 15 and 44% of patients with ascites succumbing in 1 and 5 years, respectively. Patients with cirrhosis need referral for liver transplantation after development of ascites. Proper history and physical examination are important in diagnosing the cause of ascites. Diagnostic paracentesis and abdominal sonogram should be performed during initial evaluation. Low salt diet and diuretic are the initial treatment option, and large volume paracentesis is an option for non‐responder to diuretics. Transjugular intrahepatic portosystemic stent‐shunt (TIPS) is highly valuable in properly selected patients

Feasibility study of industrial projects using Simos’ procedure

Feasibility study is conducted in a stage prior to design, procurement and construction stages in order to determine the viability of project undertaken by an investor. This helps investors to decide whether to proceed with the project or not. Multi-Criteria Decision Making (MCDM) process can be utilized in the feasibility study stage to avoid wrong decisions might cause undesired losses. In industrial projects, wrong decisions might lead to bankruptcy of crucial economic entities. Private investors might have good initiative and the capital to establish economically successful projects but they might either select the inappropriate type of industry that might turn the investment to a failure or might not include some important/crucial considerations into account. This paper presents a key-list of gathered factors that are considered the important factors and affect the selection of industrial projects. Importance, relative importance and weights of these factors are determined using Simos’ procedure. The key-list has been applied on five case-studies of industrial projects and a Weighted-Sum Model (WSM) has been selected as a MCDM technique in order to acquire their final preferences, rank them and consequently come-up with the most preferred/suitable alternative to be constructed. Then, a sensitivity analysis has been performed to determine the most critical criterion of the key-list. Additionally, several scenarios have been processed to verify that the most important criterion of the key-list does not necessarily be the most critical criterion. Moreover, the sensitivity analysis also determines the most critical measure of performance assembled from the five casestudies

The impact of spending policy shocks on the Iraqi trade balance for the period (2004-2021)

Economic shocks directly affect financial variables in the Iraqi economy, and this is due to the presence of a strong connection between the general budget and the trade balance according to Keynesian theory. So financial policy responds through its spending and revenue tools in a way that is consistent with or contrary to the direction of the economic shock, and that response is reflected in the trade balance in a way unexpected changes can be expressed in spending policy shocks. The research aims to demonstrate the impact of spending shocks on the trade balance in the Iraqi economy. Iraqi exports depend to a large extent on crude oil exports, and they are directly affected by international oil prices.           Based on the results of the cointegration test and the vector autoregressive (VAR) model for the model of spending policy and its impact on the trade balance. It was inferred that there is a long-term equilibrium relationship between the variables of the model, and the stimulated response function of the model indicates that an increase in public spending leads to an increase in the trade balance deficit, and in order Achieving stability in spending activity. It is necessary to find more stable alternative sources of revenue to finance the general budget to ensure the stability of economic activity.          The research recommended changing the course of public expenditures by changing the structure of the general budget in favor of investment spending directed to expanding production capacities and focal structures to ensure the availability of commodity and service products, and restructuring consumer spending to ensure rationalization and optimal allocation. In addition to the importance of reducing unproductive employment policies and other not sober  spending policies.

Nonalcoholic Fatty Liver Disease and the Risk of Atrial Fibrillation

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is now the factor behind the development of liver cirrhosis, liver cell failure, and liver transplantation in many cases. However, its relation to atrial fibrillation (AF) could not be cleared up. AIM: The purpose of the study was to evaluate prevalence of AF in the setting of NAFLD; the association between them, and to evaluate risk factors of AF in this category of patients. METHODS: This cross-sectional study was performed on 400 patients between January 2018 and June 2019. These patients were analyzed for the presence of NAFLD and presence of persistent or chronic AF. RESULTS: There were 138 patients with NAFLD, and 20 patients with persistent or permanent AF. Factors associated with AF were old age, male gender, and high values of aspartate aminotransferase, alanine-aminotransferase, γ-glutamyltranspeptidase, and serum uric acid. The participants with AF had a significantly greater prevalence of NAFLD than those without AF. CONCLUSION: Incidence and prevalence of atrial fibrillation in NAFLD patients were high. Severity of liver disease was an important predictor of new-onset atrial fibrillation

MAT-725: SELF LEVELING MORTAR: WHY AND HOW?

Concrete floors can develop faults over time which can cause damage thus hindering smooth transportation, industrial aspects and some residential drawbacks. In addition, flaws and cracks are known to progress into more serious damage with time and use. Self leveling mortar has been used on a relatively limited scale worldwide to allow for more even, higher performance and easy-to-apply flooring. However, there has been little information available with respect to their use and best practices. The primary focus of this work is to prepare mortar that possesses self-levelling flow characteristics. Hence, several mixtures have been designed using various constituents with moderate 28-day strength of 35 MPa. Chemical and mineral admixtures have been incorporated together with limestone to enhance the flow and cohesiveness as well as improve performance. The results reveal that self-levelling mortar can be successfully produced with comparable properties to ready-to-use market product. These mixtures were evaluated to have both performance and economic merits

Prevalence of trachoma in four marakez of Elmenia and Bani Suef Governorates, Egypt.

PURPOSE: In 2015, to determine where interventions are needed to eliminate trachoma as a public health problem from Egypt, we initiated population-based prevalence surveys using the Global Trachoma Mapping Project platform in four suspected-endemic marakez (districts; singular: markaz) of the governorates of Elmenia and Bani Suef. METHODS: In each markaz, 30 households were selected in each of 25 villages. Certified graders examined a total of 3682 children aged 1-9 years in 2993 households, noting the presence or absence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI) in each eye. A total of 5582 adults aged ≥15 years living in the same households were examined for trachomatous trichiasis (TT). Household-level access to water and sanitation was recorded. RESULTS: Three of four marakez had age-adjusted TF prevalence estimates in 1-9-year olds of >10%; the other markaz had a TF prevalence estimate of 5-9.9%. Estimates of the age- and gender-adjusted prevalence of unmanaged TT in adults ranged from 0.7% to 2.3%. Household-level access to water and sanitation was high. (We did not, however, measure use of water or sanitation facilities.) Conclusions: Each of the four marakez surveyed has trachoma as a public health problem, with a need for implementation of the SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) strategy. Further mapping is also required to determine the need for interventions in other areas of Egypt

Budesonide as a first line therapy in autoimmune hepatitis: A systematic review

BackgroundAutoimmune hepatitis (AIH) Is a chronic liver disease with female predominance. Treatment of this condition required usually a long-term corticosteroid therapy.AimsCurrent review aimed to summarize the efficacy of budesonide as a first line treatment in AIH.Methods Pub Med, ‎Google Scholar, and EBSCO ‎ databases were ‎systematically search for relevant articles. The terms ‎ ‎‎autoimmune hepatitis, budesonide, prednisolone and ‎azathioprine ‎were used. out of hundred ‎and six, only ‎five fulfilled ‎the inclusion criteria. Results Out of 106 articles, only 5 included in this review. All patients included in current review were steroid naive. Budesonide in dose of 3 mg trice a day was the used in 2 out of 5 studies both document complete platelet response in 50–80 per cent. Azathioprine was added to budesonide in 3 out of 5 studies, 60 per cent of the budesonide treated patient had a complete platelet response versus 30–40 per cent of prednisolone treated group.ConclusionIn non-cirrhotic AIH patients, budesonide was as effective as prednisolone with fewer steroid related side effects.

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

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. Funding: Bill & Melinda Gates Foundation