The Outcome of Using Long-Acting Insulin Glargine with Regular Insulin Infusion in Diabetic Ketoacidosis Patients with Renal Impairment: A Randomized Clinical Trial

Background: Diabetic ketoacidosis (DKA) is considered one of the most severe as well as immediate diabetes mellitus complications. A continuous infusion of regular insulin is the most effective technique for treatment. A long-acting insulin analog, including insulin glargine, is used to initially treat DKA by supplying background insulin. The study investigated the impact of insulin glargine on kidney disease patients with altered insulin pharmacokinetics and pharmacodynamics. Materials and Methods: The current randomized controlled trial was conducted after obtaining institutional approval (R103/2020), with clinical trial registration (NCT05219942). Fifty-two subjects were randomized into two groups. The control group included patients who received a starting regular insulin infusion dose of 0.1 IU/Kg/hour and subcutaneous saline. The study group included patients who received regular insulin infusion and subcutaneous insulin glargine. The insulin glargine dosage was modified based on the glomerular filtration rate (GFR). Results: The time required for DKA reversal was 21.15 ± 4.97 hr in controls and 17.00 ± 5.80 hr in the study group with p=0.008. The total insulin consumption until the reversal of DKA (units) in the control group was 130.85±10.31 while 108.00±21.52 in the study group and p<0.001. Rebound hyperglycemia 6 (23.1%) in controls and 1 (3.8 %) in the study group p=0.042. Intensive care unit (ICU) stay was 69.81±14.72 hr in the control group and 53.62±13.85 hr in the study group with p<0.001. Conclusion:  The addition of long-acting insulin glargine to intravenous regular insulin infusion reduces the time of DKA reversal and total insulin requirement with less liability of rebound hyperglycemia and could be safely used in renal impairment

Post-Kala-Azar Dermal Leishmaniasis: A Paradigm of Paradoxical Immune Reconstitution Syndrome in Non-HIV/AIDS Patients

Visceral leishmaniasis (VL) is a parasitic disease characterized by immune suppression. Successful treatment is usually followed by immune reconstitution and a dermatosis called post-Kala-azar dermal leishmaniasis (PKDL). Recently, PKDL was described as one of the immune reconstitution syndromes (IRISs) in HIV/VL patients on HAART. This study aimed to present PKDL as a typical example of paradoxical IRIS in non-HIV/AIDS individuals. Published and new data on the pathogenesis and healing of PKDL was reviewed and presented. The data suggested that PKDL is a typical example of paradoxical IRIS, being a new disease entity that follows VL successful treatment and immune recovery. PKDL lesions are immune inflammatory in nature with granuloma, adequate response to immunochemotherapy, and an ensuing hypersensitivity reaction, the leishmanin skin test (LST). The data also suggested that the cytokine patterns of PKDL pathogenesis and healing are probably as follows: an active disease state dominated by IL-10 followed by spontaneous/treatment-induced IL-12 priming, IL-2 stimulation, and INF-γ production. INF-γ-activated macrophages eliminate the Leishmania parasites/antigen to be followed by LST conversion and healing. In conclusion, PKDL is a typical example of paradoxical IRIS in non-HIV/AIDS individuals with anti-inflammatory cytokine patterns that are superseded by treatment-induced proinflammatory cytokines and lesions healing

Plastic use for food and drinks and related knowledge, attitudes, and practices among a sample of Egyptians

IntroductionPlastic is extensively used in everyday life, particularly for food and beverage containers. The inappropriate use of these containers may lead to the leaching of various chemicals from plastic, such as bisphenol A, phthalate, and styrene, which cause numerous adverse health effects. This study aimed to assess the knowledge, attitudes, and practices toward using plastic for food and drinks among a sample of the Egyptian population.Materials and methodsA questionnaire was designed based on scientific literature to assess sociodemographic data, knowledge, attitudes, and practices toward the use of plastic for food and drinks. A total of 639 participants were recruited by employing the convenience sampling technique.ResultsMore than half of the participants (347, 54%) had poor knowledge scores. Personal experiences, social media, and web pages represented the most common knowledge sources. A comparison between plastic-related knowledge scores and the studied sociodemographic characteristics revealed statistically significant differences in age, gender, education, marital status, residence, working, and socioeconomic standard. A good attitude was reported by the majority (515, 80.6%) of participants. The majority (493, 77.2%) were occasional and frequent plastic users and the practice scores were significantly associated with age, education, residence, and socioeconomic standard. Higher educational level, gender (women), and rural residence were predictors of good participants knowledge, while lower socioeconomic status and urban residence were predictors of bad participants practice in a multivariate logistic regression analysis.ConclusionThe observed unsatisfactory knowledge and practice scores vs. the high attitude indicates a knowledge gap that can help direct future improvements. We call for public awareness programs about safe plastic use and the related health hazards of plastic chemicals. We also stress upon the urgent need for a collaboration between health authorities and the plastic and food industry to guarantee that information about proper plastic use is conveyed to consumers

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

Democratization and the role of the military: Cases of Serbia and Tunisia

The 21st century witnessed two waves of uprisings, the Color Revolutions, which erupted in East Europe and the Arab Spring, during which the people took over the streets to demand their rights and freedoms, as well as, to oust their authoritarian rulers. Nevertheless, the outcomes of such uprisings varied considerably among the affected countries; while few were successfully able to witness a regime breakdown and a democratizing transition, others failed either to achieve a regime breakdown, or to follow a democratic transition following their regime\u27s breakdown. Thus, this research investigated why some countries have succeeded to follow a democratizing transition after mass mobilization, while others failed? What is the role of the military in such transitions? The research focused on the two outliers, democratizing cases, emerging from the Colored revolutions and the Arab Spring, which are respectively, Serbia and Tunisia and argued that the successful democratizing cases of both revolutionary waves presented and shared two factors that were not, simultaneously, present in the other failed cases; first, the refrainment of the military to use coercive power and second, the disengagement of the military from the political sphere during the transition phase. The main findings of the study validated the hypothesis by showing that the presence of the two highlighted factors simultaneously in the studied cases was a precondition to their regime breakdown and democratizing transition and that the absence of these factors interrupts the transition towards democracy. Nevertheless, the importance or contribution of these factors to the latter outcome varied across the studied cases; while they consisted a crucial aspect that enabled democratization in Tunisia, they were complementary factors in Serbia, or in other words, they were as important as other preconditions to the democratization of Serbia. Consequently, the study emphasized that the two presented factors are not the only preconditions that enabled the democratization of the two cases; they were necessary but insufficient conditions, instead, they were accompanied by other factors that were as important and contributive to the outcome, or were accompanied by secondary preconditions, as in the case of Tunisia

Correlation of transcranial Doppler based parameters with computed tomography assessed cerebral oedema score in patients with traumatic brain injury: A prospective observational study

Background and Aims: Cerebral oedema and increased intracranial pressure are associated with poor neurological outcomes in traumatic brain injury (TBI). This study aimed to examine the correlation between transcranial doppler (TCD) derived indices and computed tomography assessed cerebral oedema score in patients with TBI. Methods: This prospective observational study was conducted between April 2021 and December 2021 after approval from the University Research Ethics Committee (R75/2021) and registration with the clinicaltrials.gov (NCT04834453). Cerebral oedema on computed tomography (CT) imaging of the brain was scored as (0 = no cerebral oedema, 1 = mild cerebral oedema, 2 = moderate cerebral oedema, and 3 = severe cerebral oedema). The daily neurological assessment was performed using Glasgow coma scale score. TCD-based parameters, mean flow velocity (MFV), and pulsatility index (PI) in middle cerebral arteries were simultaneously obtained. Results: There was a significant negative correlation between MFV and cerebral oedema score (r = - 0.840, P <.001) and a significant positive correlation between PI and cerebral oedema score (r = 0.825, P <.001) on the seventh day of assessment. Significant differences were noted in MFV [53.17 ± 7.52 cm/s vs. 34.55 ± 3.35 cm/s] and PI [1.02 ± 0.16 vs. 1.46 ± 0.07] in patients with improvement and no improvement in cerebral oedema after seven days of TBI management. Conclusion: Bedside assessments of TCD-based parameters of MFV and PI correlate well with CT-based assessment of cerebral oedema in patients with TBI

Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysis of routine data from Egypt.

BACKGROUND: Between 1999 and 2007, the Ministry of Health and Population in Egypt scaled up the Integrated Management of Childhood Illness (IMCI) strategy in 84% of public health facilities. OBJECTIVES: This retrospective analysis, using routinely available data from vital registration, aimed to assess the impact of IMCI implementation between 2000 and 2006 on child mortality. It also presents a systematic and comprehensive approach to scaling-up IMCI interventions and information on quality of child health services, using programme data from supervision and surveys. METHODS: We compared annual levels of under-five mortality in districts before and after they had started implementing IMCI. Mortality data were obtained from the National Bureau for Statistics for 254 districts for the years 2000-2006, 41 districts of which were excluded. For assessment of programme activities, we used information from the central IMCI data base, annual progress reports, follow-up after training visits and four studies on quality of child care in public health facilities. RESULTS: Across 213 districts retained in the analysis, the estimated average annual rate of decline in under-five mortality was 3.3% before compared with 6.3% after IMCI implementation (p=0.0001). In 127 districts which started implementing IMCI between 2002 and 2005, the average annual rate of decline of under-five mortality was 2.6% (95% CI 1.1% to 4.1%) before compared with 7.3% (95% CI 5.8% to 8.7%) after IMCI implementation (p<0.0001). IMCI implementation also led to marked improvements in the quality of child health services. INTERPRETATION: IMCI implementation was associated with a doubling in the annual rate of under-five mortality reduction (3.3% vs 6.3%). This mortality impact is plausible, since substantial improvements occurred in quality of care provided to sick children in health facilities implementing IMCI

Promoting students' health awareness and higher order thinking skills using E-projects strategy in learning physical and health education

BACKGROUND: Health awareness and higher-order thinking skills have become important requirements for higher education students because these skills make students effective problem-solvers. So, this study aimed to promote students' health awareness and higher-order thinking skills through the E-projects strategy in learning physical and health education.MATERIALS AND METHODS: The experimental study was conducted at Imam Abdulrahman bin Faisal University, KSA, from September 5 to December 23, 2021. The study was conducted on 250 students (age: 18.23 ± 0.66 years). They were divided into 10 groups each group prepared a different E-project according to the intended learning outcomes of the physical and health education course. To collect data, two scales were designed, the first to measure health awareness and the second to measure higher-order thinking skills. Moreover, the ADDIE model was used during the implementation of the E-projects strategy in learning. The collected data were analyzed using SPSS version 22 software. The level of significance was set at P ≤ 0.05.RESULTS: The results showed that there were statistically significant differences between pre and post-measurement in all studied variables in favor of post-tests for the experimental group, as the mean differences in health awareness were (29.33) and ranged from (8.63: 10.01) in higher-order thinking skills (HOTS), the percentages of improvement for health awareness was 14.66%. While the rates of improvement in the higher-order thinking skills ranged between 26.28% to 48.78%.CONCLUSION: The major conclusion drawn from this study was that the application of the E-projects strategy in learning physical and health education using the ADDIE model significantly influences the improvement of students' health awareness and higher-order thinking skills in higher education