A case report on digoxin toxicity

Digoxin is an inotropic drug that is commonly prescribed in patient with heart related diseases. The effective dose of digoxin is 0.8-2.0 ng/ml beyond which digoxin causes toxic effects like visual dysfunction, irregular heartbeat, and cardiovascular collapse. Digoxin toxicity is caused due to increased automaticity and inotropy due to intracellular calcium and decreased dromotropy due to poisoning of sodium potassium transporter and AV nodal blockade. Digoxin toxicity should be assessed by continuous hemodynamic and cardiac monitoring including 12-lead electrocardiogram. There should be timely and immediate evaluation of electrolyte levels like potassium, calcium, serum creatinine and digoxin levels and prompt intensive care unit admission, if necessary. In this case study we studied a 43 old female patient prescribed with digoxin 0.25 mg, who had a medical history of congestive cardiac failure presented with symptoms of digoxin toxicity. The patient was assessed with electrocardiography (ECG) and managed by keeping digoxin on hold and effective patient counselling

Nonsurgical Maxillary Expansion in Adults: Report of Two Cases

Correction of maxillary transverse discrepancy requires expansion of palate by combination of orthopedic and orthodontic movements. Isolated maxillary transverse deficiency can be treated either orthodontically or surgically with assisted rapid maxillary expansion (RME). Nonsurgical expansion modalities include rapid maxillary expansion and slow maxillary expansion. Haas popularized the idea of orthodontic palatal expansion in the 1960s, and since then transverse deficiencies have been treated successfully  in children and adolescents. The use of palatal expanders in adults was widely frowned upon and was generally considered to be unsuccessful. Handelman published a clinical review in 1997, proving a nonsurgical expansion in adults was possible

Teaching strategies to facilitate active learning in a private nursing education institution

Nurse educators are the custodians of nursing education and are faced with the task of providing quality nursing education in a way that inspires and enhances learning. The approach to teaching has moved away from the traditional teacher centre approach to a more student centred, active learning approach. Nurse educators are faced with many challenges, such as creating a learning environment that is conducive to a new and diverse generation of students who have different needs, learning styles and expectations. It is therefore important that the nurse educators strive to enhance the overall learning experience by incorporating teaching strategies that engage students as active participants in the learning process. This study followed a quantitative, descriptive, exploratory and contextual research design in order to determine the activities, educational resources and teaching strategies used to facilitate active learning in a private nursing education institution. The target population was comprised of student nurses registered at the private nursing education institution. The data was collected by means of a self-administered questionnaire from 721 participants at learning centres throughout the country. The statistician used Statistica Version 12 to obtain both a descriptive and a statistical summary of the data. Descriptive statistics were used to describe the common features of the data used and the findings were discussed and summarized in tables and graphs. The ethical principles of informed consent, confidentiality and anonymity, beneficence, non-maleficence, veracity and justice have been maintained throughout this study. This study was conducted in one private nursing education institution in South Africa and only focussed on student nurses. The findings were that the greater majority of the students were encouraged to actively participate in the classroom. Students voiced their preference regarding the activities and teaching strategies utilized. There is disparity and inequality regarding the availability of educational media, resources and facilities. A variety of teaching strategies were utilized in the classrooms of the private NEI, but the use of technology based teaching strategies was limited. Information obtained from nurse educators could provide clarity on their use of teaching strategies to facilitate active learning in the classroom or at least highlight gaps in their knowledge that could help to facilitate training for nurse educators. Based on the findings of the study, recommendations for nursing practice, research and nursing education were made. The main recommendations for nursing education include the continuation of active learning activities given by the nurse educators in the classroom. Nurse educators to take cognisance of the students’ preferences and justify their selection of teaching strategies. The private NEI should ensure the availability and accessibility of educational resources, multimedia and facilities that are essential in teaching students to become self-directed, independent practitioners. Opportunities should be made available for nurse educators to attend seminars or workshops on the use of technology-based teaching strategies and undergo training in the utilization of different strategies that can enhance active learning. This could be included as a mandatory module of the nurse educators’ continuous professional development

Security vulnerabilities related to web-based data

In this digital era, organizations and industries are moving towards replacing websites with web applications for many obvious reasons. With this transition towards web-based applications, organizations and industries find themselves surrounded by several threats and vulnerabilities. One of the largest concerns is keeping their infrastructure safe from attacks and misuse. Web security entails applying a set of procedures and practices, by applying several security principles at various layers to protect web servers, web users, and their surrounding environment. In this paper, we will discuss several attacks that may affect web-based applications namely: SQL injection attacks, cookie poisoning, cross-site scripting, and buffer overflow. Additionally, we will discuss detection and prevention methods from such attacks

The role of surfactants in inhibition of uropathogenic E. coli biofilm in catheterized patients in Assiut University Hospitals.

Background: Escherichia coli (E. coli) represent one of the major pathogens implicated in catheter associated urinary tract infection (CAUTI). Formation of biofilm by uropathogenic E. coli (UPEC) is a major survival and persistence mechanism of bacteria against antibiotics and host immune responses in the bladder. This study was designed aiming to evaluate the role of surfactants [non-anionic: Tween 80, anionic: sodium dodecyl sulfate (SDS), cationic: cetyl trimethyl ammonium (CTMA)] on biofilm forming CsgA gene containing strains of E. coli. Methods: A cross sectional study conducted at Assiut University Hospitals ICUs included 100 patients; 53 males and 47 females, catheterized for at least 3 days. Biofilm production by E. coli isolates was detected phenotypically by culture on Congo red agar plates and confirmed genotypically by detection of CsgA by conventional PCR. Overnight broth culture of each E. coli isolate was incubated with each surfactant at 3 different concentrations (CMC). Subculture on congo red agar plates was done. Inhibition of biofilm formation was indicted by fading or absence of black color of the colonies. Results: Tween 80 showed inhibition of biofilm formation by 15% of all samples at a concentration 0.1% (>CMC). SDS show biofilm inhibition by 23% at concentration 2.32mg/ml (=CMC) and at concentration 3mg/ml (>CMC). CTMA inhibited the biofilm formation by 7% at a concentration 0.4mg/ml (=CMC) and by 38% at a concentration 0.8mg/ml (>CMC). Conclusion: Surfactants have disruptive and inhibitory effect on biofilm formation that provides an alternative for plain and medicated catheters

The relationship between the gut microbiota shifts and the inflammatory biomarkers in obese and normal weight adults

Background:Healthy obesity means obese individuals remain free of metabolic health complications. Several researches link microbiota changes to obesity, focus on metabolic role of IL-6 and its ability to alter fat metabolism and correlate circulating calprotectin concentration to morbid obesity. This study evaluated the relative abundance of gut microbiota (Prevotella and γ-Proteobacteria), estimated the serum levels of inflammatory mediators (IL-6 and calprotectin) and studied the correlation between them in healthy obese and normal weight adults. Methods: 33 healthy obese (HO) and 14 normal weight (NW) controls were included. Serum levels of IL-6 and calprotectin were estimated by ELISA. Abundances of Prevotella and γ-Proteobacteria were determined in stool using real time PCR. Results: IL-6 and calprotectin levels were significantly lower in HO than in NW (p=0.001, p=0.001 respectively) with significant negative correlation between IL-6 and body mass index (BMI) in HO (r=-0.438, p=0.011) and negative but statistically insignificant correlation with BMI in NW groups (r=-0.024, p=0.935). There was negative but statistically insignificant correlation between calprotectin and BMI in HO (r=-0.075, p=0.677) and NW (r=-0.381, p=0.179). Prevotella and γ-Proteobacteria abundances were higher in HO than in NW and insignificant (p=0.31, p=0.55 respectively) with significant positive correlation between Prevotella and γ-Proteobacteria abundance in HO (r=0.436, p=0.011), positive and insignificant correlations between abundance of Prevotella and levels of IL-6 in HO and NW (r=0.303, P=0.086 vs r=0.316, p=0.272 respectively). Conclusion: IL-6 and calprotectin have role in regulation of energy homeostasis. Elevated abundances of Prevotella and γ-Proteobacteria may be the primary shifts in gut microbiota of  HO

FORMULATIONS AND TECHNOLOGIES IN GROWTH HORMONE DELIVERY

Growth hormone treatment has many indications including the treatment of growth hormone deficiency, Prader–Willi syndrome, chronic renal insufficiency, Turner syndrome, AIDS-related wasting, idiopathic short stature in children, and accumulation of fat which related in adults with lipodystrophy. Conventional therapy was achieved using intramuscular and subcutaneous injections. However, noncompliance was very high. To solve this; many studies have been attempted to prepare long-acting formulations and new to make derivatives of growth hormone and to use alternative routes of administration which term as noninvasive routes such as intranasal, pulmonary, transdermal and oral. New delivery systems were also used such as needle-free and auto-injector devices. In this review, different formulations, technologies, and routes of growth hormone delivery will be presented with the discussion of the principles of formulations and selected additives that were used to achieve improved growth hormone formulations

THE IMPACT OF TRADE ACCOUNT DEFICIT ON UNEMPLOYMENT SCENARIO: AN EMPIRICAL STUDY ON JORDAN DURING THE PERIOD OF 2000-2012

The aim of this paper is to study the short-term causal relationship between unemployment and the volume of trade deficit in jordan for the period 2000:01 – 2012:02. This study provides evidence of the absence of a long-term relationship between the two variables. We use granger causality test and propose an augmented dickey-fuller (adf) coefficient test for detecting the presence of a unit root in the model. The results show that trade account deficit causes unemployment, and unemployment causes the trade account deficit in the short run. This indicates that trade liberalization is also able to increase imports, decrease aggregate productivity in the differentiated sectors, and create inefficiency on economic performance. Thus, this would simultaneously decrease employment opportunities for jordan’s labour force. Trade account can also be an additional negative effect in increasing jordanian’s unemployment scenario in the future

IMPACT OF COVID-19 ON ECT PRACTICE IN QATAR

There is paucity of Electroconvulsive therapy (ECT) utilization surveys from the Arabian Gulf region and none available from Qatar. There is no literature available on impact of Coronavirus Disease 2019 (COVID-19) pandemic on ECT provision. ECT is a lifesaving treatment in psychiatric practice requiring anesthetic support and there were concerns that redeployment of anesthetists due to COVID-19 pandemic might have comparatively bigger impact on the provision of ECT. These concerns stem from the fact that psychiatric patients often get discriminated against in health care systems; largely due to stigma and the belief among healthcare providers that psychiatric illness is somehow not as serious as other types of medical or surgical illness. In this brief report we present pre-COVID ECT utilization from Qatar. We also report findings on ECT utilization during COVID-19 and compare changes with other elective and non-elective surgeries. ECT provision was down by 40% during March to August 2020 in our setting. The decline in ECT provision was comparable to other elective and non-elective surgeries