Effect of Intravenous Dexmedetomidine Infusion on Interleukin-6 (IL-6) and Plasma Cortisol in Open Heart Surgery

Aim of the work: to evaluate the effect of intravenous dexmedetomidine infusion on patients undergoing open heart surgery regarding stress response markers as plasma interleukin-6 and plasma cortisol. Patents and Methods: Fifty consecutive patients aged 18-70years, scheduled for elective open heart surgery using CPB technique were enrolled in this study at the Cardiothoracic Surgery Unit, Luxor international hospital, from July 2018 to May 2019. Patients randomly assigned using closed envelope technique into two equal groups according to the drug infused intraoperatively: 1st group (25 patients):- Dexmedetomidine group (Group D); received loading dose of intravenous dexmedetomidine infusion of 1 μg/kg IV dissolved in 20ml normal saline over 10 minutes followed by maintenance dose of 0.5 μg/kg/hr. till the end of surgery where 0.5 μg /kg/h was calculated for each patient and dissolved in 12.5 ml normal saline 2nd group ( 25 patients):- placebo group (Group P); receive 20ml intravenous infusion of normal saline 0.9 % over 10 minutes followed by continuous infusion of 12.5 ml of normal saline till the end of surgery. Results: Our study revealed that HR and MAP wasn’t significantly different between the two groups at the baseline, but significantly lowered in Dex. group after induction, during CPB, post CPB, and postoperative.Dexometomedine suppress the intraoperative and postoperative rise of IL-6 which was significantly higher in placebo group relative to Dex. group. Also dexometomedine has effect on stress hormone as serum cortisol and serum glucose decease in Dex. group relative to placebo group. None of studied cases revealed bradycardia or hypotention and there are no significant difference between groups regarding side effect drowsiness, nausea and vomiting Conclusion: This study demonstrated that the continuous administration of dexmedetomidine during open heart surgery with CPB suppressed intraoperative and post-operative cytokine secretion, and improved post-operative inflammatory response indices in the present study. Also it stabilize blood pressure and heart rate and blunt cardiovascular response to CPB. These results could be attributed to the anti-inflammatory effects of dexmedetomidine

Medical Residents of Family Medicine Management of Depression, Anxiety and Burnout Syndrome in KSA

This study aimed at analyzing the Medical Residents of family medicine management of depression, anxiety and burnout syndrome in Kingdom Saudi Arabia. This study also describes the relationship between wellness behaviors and measures of well-being at the start of family medicine residency in Kingdom Saudi Arabia. The researcher adopted the Methodology of descriptive statistics. And the study concluded that the innovative curriculum and activities that focus on wellness behaviors and healthy lifestyle choices for physicians in training are needed. The ACGME mandate on implementation of duty hours for residents may show a positive effect in future generations of physicians. Family medicine programs can lead in creating additional institutional methodologies to support a culture of wellness for residents, faculty, and staff, thus promoting a lifelong commitment to self-care and an emphasis on prevention and health promotion for our patients.

Genotoxic and Anatomical Deteriorations Associated with Potentially Toxic Elements Accumulation in Water Hyacinth Grown in Drainage Water Resources

Potentially toxic elements (PTEs)-induced genotoxicity on aquatic plants is still an open question. Herein, a single clone from a population of water hyacinth covering a large distribution area of Nile River (freshwater) was transplanted in two drainage water resources to explore the hazardous effect of PTEs on molecular, biochemical and anatomical characters of plants compared to those grown in freshwater. Inductivity Coupled Plasma (ICP) analysis indicated that PTEs concentrations in water resources were relatively low in most cases. However, the high tendency of water hyacinth to bio-accumulate and bio-magnify PTEs maximized their concentrations in plant samples (roots in particular). A Random Amplified Polymorphic DNA (RAPD) assay showed the genotoxic effects of PTEs on plants grown in drainage water. PTEs accumulation caused substantial alterations in DNA profiles including the presence or absence of certain bands and even the appearance of new bands. Plants grown in drainage water exhibited several mutations on the electrophoretic profiles and banding pattern of total protein, especially proteins isolated from roots. Several anatomical deteriorations were observed on PTEs-stressed plants including reductions in the thickness of epidermis, cortex and endodermis as well as vascular cylinder diameter. The research findings of this investigation may provide some new insights regarding molecular, biochemical and anatomical responses of water hyacinth grown in drainage water resources.</jats:p

False Beliefs About Diabetes Mellitus in the Kurdistan Region of Iraq: A Population-Based Study

Background. Diabetes mellitus (DM) is a chronic, non-transmissible health condition distinguished by high blood glucose levels caused by faulty insulin secretion and impaired insulin activity. People play an essential role in preventing and managing their illnesses. Thus, the misconceptions may negatively influence the prevention and management of DM. The aim of this study was to gauge the extent of knowledge among the general population concerning DM, to determine the prevalence of misconceptions about DM in the community, and to find the factors influencing them. Methods. A population-based study was conducted in Duhok Province, the Kurdistan Region of Iraq. A total of 2,305 adults were enrolled in the study. The study data were collected by face-to-face interview. The survey questionnaire comprised two sections: the first section included basic demographic characteristics of participants, while the second section consisted of ten questions to identify common misconceptions about DM among participants. Results. Among the participants, there were 1,406 (61.0%) females. Participants’ age ranged from 18 to 90 years (the mean age: 54 ± 13.69 years). The most common misconceptions positively responded to were “Will I become addicted to insulin if I start taking it?”, followed by“ Does DM occur because of increased sugar intake?”. Male gender was associated with higher level of misconceptions. In addition, the misconceptions were more prevalent among diabetics as they might seek treatment from non-professionals. There was a significant association between education status and the prevalence of misconceptions. Healthcare workers were found to have a better knowledge about DM compared to the general population. Surprisingly, certain myths were prevalent even among healthcare workers. Conclusions. Certain myths and misconceptions have been pervasive in our society. Actions must be taken to dispel these misconceptions as they lead to an avoidable burden of disease. Therefore, people’s knowledge of DM needs to be enhanced through educational programs, social media, television, newspapers and campaigns

Driving Active Contours to Concave Regions

Broken characters restoration represents the major challenge of optical character recognition (OCR). Active contours, which have been used successfully to restore ancient documents with high degradations have drawback in restoring characters with deep concavity boundaries. Deep concavity problem represents the main obstacle, which has prevented Gradient Vector Flow active contour in converge to objects with complex concavity boundaries. In this paper, we proposed a technique to enhance (GVF) active contour using particle swarm optimization (PSO) through directing snake points (snaxels) toward correct positions into deep concavity boundaries of broken characters by comparing with genetic algorithms as an optimization method. Our experimental results showed that particle swarm optimization outperform on genetic algorithm to correct capturing the converged areas and save spent time in optimization process

Patients with Chronic Kidney Disease and Their Quality of Life

This study aimed at exploring the assessment of Quality of Life (QOL) in patients with Chronic Kidney Disease (CKD), and aiming at assessing the QOL of patients with stages 1–5 Chronic Kidney Disease CKD on conservative treatment in order to identify a possible association between Quality Of Life QOL and progression of kidney insufficiency. The results were compared with those obtained for patients on hemodialysis. Sociodemographic, clinical and laboratory data were also evaluated. And the study concluded that research efforts have expanded significantly to determine the state of pediatric CKD patient HRQOL and the factors that impact HRQOL across all stages of CKD and all modalities of renal replacement therapy. Data from all studies suggest that children with a renal transplant fare better with respect to HRQOL than those receiving dialysis.

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

Defining criteria for disease activity states in systemic juvenile idiopathic arthritis based on the systemic Juvenile Arthritis Disease Activity Score

Objective To develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis (sJIA), based on subjective disease state assessment by the treating pediatric rheumatologist. Methods The cutoffs definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, 6 methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, Youden index, 90% specificity, maximum agreement, and ROC curve analysis. Sixty percent of the patients were assigned to the definition cohort and 40% to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. Results The sJADAS10 cutoffs that separated ID from MiDA, MiDA from MoDA, and MoDA from HDA were ≤ 2.9, ≤ 10, and > 20.6. The cutoffs discriminated strongly among different levels of pain, between patients with or without morning stiffness, and between patients whose parents judged their disease status as remission or persistent activity/flare or were satisfied or not satisfied with current illness outcome. Conclusion The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts, and are therefore suitable for use in clinical trials and routine practice

Impacts of biomedical hashtag-based Twitter campaign: #DHPSP utilization for promotion of open innovation in digital health, patient safety, and personalized medicine

The open innovation hub Digital Health and Patient Safety Platform (DHPSP) was recently established with the purpose to invigorate collaborative scientific research and the development of new digital products and personalized solutions aiming to improve human health and patient safety. In this study, we evaluated the effectiveness of a Twitter-based campaign centered on using the hashtag #DHPSP to promote the visibility of the DHPSP initiative. Thus, tweets containing #DHPSP were monitored for five weeks for the period 20.10.2020–24.11.2020 and were analyzed with Symplur Signals (social media analytics tool). In the study period, a total of 11,005 tweets containing #DHPSP were posted by 3020 Twitter users, generating 151,984,378 impressions. Analysis of the healthcare stakeholder-identity of the Twitter users who used #DHPSP revealed that the most of participating user accounts belonged to individuals or doctors, with the top three user locations being the United States (501 users), the United Kingdom (155 users), and India (121 users). Analysis of co-occurring hashtags and the full text of the posted tweets further revealed that the major themes of attention in the #DHPSP Twitter-community were related to the coronavirus disease 2019 (COVID-19), medicine and health, digital health technologies, and science communication in general. Overall, these results indicate that the #DHPSP initiative achieved high visibility and engaged a large body of Twitter users interested in the DHPSP focus area. Moreover, the conducted campaign resulted in an increase of DHPSP member enrollments and website visitors, and new scientific collaborations were formed. Thus, Twitter campaigns centered on a dedicated hashtag prove to be a highly efficient tool for visibility-promotion, which could be successfully utilized by healthcare-related open innovation platforms or initiatives

The International Natural Product Sciences Taskforce (INPST) and the power of Twitter networking exemplified through #INPST hashtag analysis

Background: The development of digital technologies and the evolution of open innovation approaches have enabled the creation of diverse virtual organizations and enterprises coordinating their activities primarily online. The open innovation platform titled "International Natural Product Sciences Taskforce" (INPST) was established in 2018, to bring together in collaborative environment individuals and organizations interested in natural product scientific research, and to empower their interactions by using digital communication tools. Methods: In this work, we present a general overview of INPST activities and showcase the specific use of Twitter as a powerful networking tool that was used to host a one-week "2021 INPST Twitter Networking Event" (spanning from 31st May 2021 to 6th June 2021) based on the application of the Twitter hashtag #INPST. Results and Conclusion: The use of this hashtag during the networking event period was analyzed with Symplur Signals (https://www.symplur.com/), revealing a total of 6,036 tweets, shared by 686 users, which generated a total of 65,004,773 impressions (views of the respective tweets). This networking event's achieved high visibility and participation rate showcases a convincing example of how this social media platform can be used as a highly effective tool to host virtual Twitter-based international biomedical research events