Nutritional Status among Children under Five Years in Amman, Jordan

Objectives: There is scarcity of data on malnutrition among children in Jordan. Therefore, this study was conducted to assess the nutritional status and estimate the prevalence rates of stunting, underweight, and wasting and their associated factors among children under five. Subjects and Methods: A cross-sectional study was conducted between January and April 2017 among children under five years in Amman, Jordan. All Jordanian children under five years who visited the selected health centers for vaccination or accompanied their mothers during the study period were included in this study. Mothers or caregivers of children were interviewed face-to face using the study questionnaire. Weight in kilograms and height in centimeters were measured for all children. Anthropometric indices were calculated using reference medians recommended by the World Health Organization. Results: This study included a total of 923 (463 boys and 460 girls) children. The prevalence rates of stunting, underweight, and wasting were 6.2%, 3.8%, and 2.8%, respectively. Multivariate analysis showed that low birth weight was significantly associated with stunting (OR = 2.9, 95% CI: 1.4,6.0; p-value=0.003) and underweight (OR =5.6, 95% CI: 2.5,12.3, p-value <0.001). Compared to exclusive breastfeeding, mixed feeding was associated with increased odds of stunting (OR =2, 95% CI: 1.1-3.9, p-value =0.029) and underweight (OR = 2.2, 95% CI: 1.002, 5.0; p = 0.049). None of the variables were significantly associated with wasting. Conclusions: The prevalence rates of stunting, wasting and undernutrition among children under five years in Jordan are low. Low birth weight and mixed feeding were associated with higher rates of malnutrition

Acoustic echo cancellation using adaptive filtering algorithms for quranic accents (Qiraat) identification

Echoed parts of Quranic accent (Qiraat) signals are exposed to reverberation of signals especially if they are listened to in a conference room or the Quranic recordings found in different media such as the web. Quranic verse rules identification/Tajweed are prone to additive noise and may reduce classification results. This research work aims to present our work towards Quranic accents (Qiraat) identification, which emphasizes on acoustic echo cancellation (AEC) of all echoed Quranic signals during the preprocessing phase of the system development. In order to conduct the AEC, three adaptive algorithms known as affine projection (AP), least mean square (LMS), and recursive least squares (RLS) are used during the preprocessing phase. Once clean Quranic signals are produced, they undergo feature extraction and pattern classification phases. The Mel Frequency Cepstral Coefficients is the most widely used technique for feature extraction and is adopted in this research work, whereas probabilities principal component analysis (PPCA), K-nearest neighbor (KNN) and gaussian mixture model (GMM) are used for pattern classification. In order to verify our methodology, audio files have been collected for Surat Ad-Duhaa for five different Quranic accents (Qiraat), namely: (1) Ad-Duri, (2) Al-Kisaie, (3) Hafs an A’asem, (4) IbnWardan, and (5) Warsh. Based on our experimental results, the AP algorithm achieved 93.9 % accuracy rate against all pattern classification techniques including PPCA, KNN, and GMM. For LMS and RLS, the achieved accuracy rates are different for PPCA, KNN, and GMM, whereby LMS with PPCA and GMM achieved the same accuracy rate of 96.9 %; however, LMS with KNN achieved 84.8 %. In addition, RLS with PPCA and GMM achieved the same accuracy rate of 90.9 %; however, RLS with KNN achieved 78.8 %. Therefore, the AP adaptive algorithm is able to reduce the echo of Quranic accents (Qiraat) signals in a consistent manner against all pattern classification techniques

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Is diet partly responsible for differences in COVID-19 death rates between and within countries?

Correction: Volume: 10 Issue: 1 Article Number: 44 DOI: 10.1186/s13601-020-00351-w Published: OCT 26 2020Reported COVID-19 deaths in Germany are relatively low as compared to many European countries. Among the several explanations proposed, an early and large testing of the population was put forward. Most current debates on COVID-19 focus on the differences among countries, but little attention has been given to regional differences and diet. The low-death rate European countries (e.g. Austria, Baltic States, Czech Republic, Finland, Norway, Poland, Slovakia) have used different quarantine and/or confinement times and methods and none have performed as many early tests as Germany. Among other factors that may be significant are the dietary habits. It seems that some foods largely used in these countries may reduce angiotensin-converting enzyme activity or are anti-oxidants. Among the many possible areas of research, it might be important to understand diet and angiotensin-converting enzyme-2 (ACE2) levels in populations with different COVID-19 death rates since dietary interventions may be of great benefit.Peer reviewe

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Manazil al-firdaous. Commentaire, par Mohammad ibn Khalil Mohammad ibn Khalil ibn Ghalboun al-Azhari al-Malaki, sur le traité d'astrologie en vers intitulé al-maknaʿ fil-ikhtisar (sic) ʿilm Abi Mokraʿ, par Mohammad ibn Saʿid al-Sousi al-Marghati.

Al-Maknaʿ fi ikhtisar ʿilm Abi MokraʿManazil al-firdaousNumérisation effectuée à partir d'un document de substitution

Recueil de traités sur la lecture du Koran.

Al-Dakaïk al-mouhkama fi sharh al-MokaddamaAl-Kawaʿid al-moukarrara wal-fawaïd al-mouharraraAl-Mokaddimat al-manzouma fi tadjwid al-KorʾanKitab al-taïsir fil karaʾat al-sabʿNumérisation effectuée à partir d'un document de substitution.Le al-Kawaʿïd al-moukarrara wal-fawaïd al-mouharrara, opuscule sur la lecture du Koran, par Mohammad ibn Qāsim Ismaʿïl al-Bakri al-Shafïʿi al-Azhari, d'après l'enseignement d' ʿAbd ar-Rahman al-Yamani ; cet ouvrage a été terminé en 1126 de l'hégire / 1714, et sa copie est datée du mois de Zilhidjdja 1155 de l'hégire / 27 janvier-24 février 1743- (folio 2 verso) ; le al-Dakaïk al-mouhkama fi sharh al-Mokaddama, commentaire, composé en Shawwal 883 de l'hégire / 26 décembre 1478-23 janvier 1479, par un auteur anonyme, sur la al-Mokaddamat al-manzouma fi tadjwid al-Koran, traité en 107 (sic) vers, sur la lecture du Koran, par le shaïkh al-Islam Aboul-Khaïr Mohammad ibn Mohammad al-Djazari (folio 17 verso) ; le Kitab al-taïsir fil-karaʾat al-sabʿ, traité sur la lecture du Koran, d'après les règles des sept lecteurs, par Abou ʿAmrou ʿOthman ibn Saʿïd al-Mokri ; la copie fut exécutée en 1156 de l'hégire / 1743-1744, par Mohammad ibn Ibrahim ibn ʿAli (folio 44 verso)