The value of Holter monitoring in the assessment of Pediatric patients

Aims: Holter monitoring (HM) has been established as one of the most effective noninvasive clinical tools in the diagnosis, assessment and risk stratification of cardiac patients. However, studies in the pediatric age group are limited. The present work aims at determining the value of HM in the diagnosis and management of children. Settings and Design: Retrospective study conducted at a tertiary referral arrhythmolology service.Methods and Material: Holter records of 1319 pediatric patients (54.1% males and 45.9% females) were reviewed. Their average age was 6.7± 4.1 years (5 days-16 years). Indications for which Holter monitoring was done were analysed as well as all the abnormalities diagnosed and factors that may increase Holter yield.Statistical analysis used: Statistical Package of social science (SPSS) version 9,0 was used for analysis of data. Results: The most common indications were palpitations (19.8%), syncope (17.8%), cardiomyopathy (12.6%), chest pain (10%), evaluation of antiarrhythmic therapy (6.8%), postoperative assessment (2.6%) and complete AV Block (2.4%). A sum of 141 Holter recordings were found abnormal with a total diagnostic yield of 10.7%. The highest contribution to diagnosis was in postoperative assessment (32.4%) and in cardiomyopathy (19.9%) where the most common abnormalities were frequent supraventricular / ventricular premature beats, supraventricular tachycardia, ventricular tachycardia and AV block. Diagnostic yield was low in patients with palpitations (5.7%) and syncope (0.4%). An abnormal ECG was significantly associated with a higher diagnostic yield (p=0.0001). None of the children with chest pain had abnormal Holter recordings.Conclusions: HM has an extremely valuable role in the assessment of high risk patients (postoperative and cardiomyopathy). However in children with palpitations, syncope and chest pain HM has a low yield. In this group of patients an abnormal ECG is more likely to be associated with abnormal Holter recordings

Systematic review of brucellosis in the Middle East: disease frequency in ruminants and humans and risk factors for human infection

This paper considers the problem of finding global states incoming to a specified global state in a Boolean network, which may be useful for pre-processing of finding a sequence of control actions for a Boolean network and for identifying the basin of attraction for a given attractor, We show that this problem is NP-hard in general along with related theoretical results, On the other hand, we present algorithms that are much faster than the naive exhaustive search-based algorithm. ©2007 IEEE.link_to_subscribed_fulltex

Diagnostic Dilemma of Cardiac Syncope in Pediatric Patients

Aims Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests.Settings and Design Retrospective study conducted at a tertiary referral arrhythmolology serviceMethods and Material The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 ± 3.82(3.5-16) years were reviewed by the investigators.Statistical analysis used Statistical Package of social science (SPSS) version 9,0 was used for analysis of data.Results The commonest trigger for syncope in the study population was early following exercise (n=65) and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3%) while 10.7% (n=25) had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2%) were abnormal. Only two of them were missed by ECG. All patients were offered ambulatory 24 hour ECG. One patient with sick sinus syndrome was diagnosed only with Holter.Conclusions Clues to the presence of cardiac syncope may include acute onset of syncope, frequent episodes, low difference between blood pressure readings in supine and erect positions (after standing for 2 minutes) and most importantly an abnormal 12 lead ECG. Transthoracic echo and Holter monitoring have low yield in pediatric syncope

An inverted virtual faculty development program for remote teaching: pilot for replication

Background: Due to the COVID 19 pandemic, all the universities worldwide are experiencing a paradigm shift to online learning. Baby boomers and Generation X need to cope with the challenging transformation, so an emerging need for a faculty development program was needed towards achieving the goal of that transformation. Objectives: To describe and assess an inverted virtual faculty development program (VFDP) that was designed and implemented for the first time in the school to equip educators with the necessary technology competencies for remote online learning. Methods: An interventional prospective study held in a university setting post need analysis conduction to prioritize the required technological skills for faculty members. The program was designed to integrate five essential skills needed to by faculty members to teach remotely. The intervention comprised attending five virtual sessions after watching a pre-distributed material, then evaluated using the Kirkpatrick model.Results: Almost 81% of faculty members completed the program and 80 % of participants were satisfied with the content of the program. There was a statistically significant difference between the perceived ability of the participants to share and record video lectures before and after the VFDP (p value <0.001). The percentage of the departments that applied the program components showed that 96% of them were able to record lectures. In addition, 80% of them were able to develop online quizzes. Conclusion: The inverted virtual faculty development program (VFDP) has supported the participating faculty in developing their needed technological competencies required to bridge the gap of remote teaching/learning

Immunohistochemical Study of Stellate Cells in Patients with Chronic Viral Heptitis C Histopathological study

Background: Chronic hepatitis is defined as liver inflammation that lasts for at least 6 months. The Hepatitis C virus is responsible for 60 to 70% of chronic hepatitis cases; the virus causes continued inflammation that slowly damages the liver, eventually leading to cirrhosis, liver failure, and, in rare cases, liver cancer. Aim of the work: To evaluate the changes in distribution and percentage of alpha-smooth muscle actin-positive hepatic stellate cells and the correlation with the degree of the fibrosis in cirrhotic livers, in patients with HCV chronic hepatitis. Material and methods: 50 hepatic core biopsies selected randomly were received from Histopathology Department at National Hepatology and Tropical Medicine Research Institute and examined for histopathological features using (hematoxylin and eosin), stage of hepatic fibrosis using stellate cell Masson s' trichrome stain, and examined for stellate cell activity using alpha smooth muscle actin (ASMA) immunostaining. Results: The relation between degree of ASMA expression by stellate cells and stage of fibrosis was highly significant with a p value <0.001, also the relation between degree of necroinflammation and degree of ASMA expression by stellate cells was highly significant with a p value <0.001. The relation between degree of necroinflammation and stage of fibrosis was highly significant with a p value <0.001. The relation between age of patient and stage of fibrosis also was statistically significant with a p value =0.012. The relation between age of patient and degree of necroinflammation was statistically significant with a p value =0.017. Conclusion: To summarize from hepatic core biopsies of patients suffering from chronic HCV, the number of active stellate cells was found to be positively associated with stage of hepatic fibrosis

Meeting report: ‘How do I incorporate research into my family practice?’: Reflections on experiences of and solutions for young family doctors

Background: Family doctors (FDs) focus on biopsychosocial components of health during consultations. However, much of the evidence employed by these doctors is produced by researchers who are not routinely involved in family practice. Family doctors competent in both clinical practice and research are essential to addressing this gap. With the growing recognition of family medicine as the specialty of choice for many young doctors, there is a scarcity of literature that describes their experiences in combining research and daily family practice. Aim: Members from Young Doctor Movements (YDMs) under the auspices of the World Organisation of Family Doctors (WONCA) sought to address this knowledge gap by reflecting on their experiences towards becoming researchers. With the assistance of senior doctors, they explored solutions that can help young FDs incorporate research into their family practice. Methods: Following an online YDM meeting, a summary of the experiences of young FDs as well as strategies useful for incorporating research into their everyday practice as FDs was prepared. Result: Nine thematic areas were derived, including experiences and motivation towards regular research, culture and environment of practice, relevance and gains of research, teamwork and mentorship. Conclusion: Family practices can incorporate research by promoting a personal and organisational research culture, highlighting gains and relevance of making it part of the profession and fostering teamwork, supportive networks and mentorship while making it enjoyable

Professional Memory CD4+ T Lymphocytes Preferentially Reside and Rest in the Bone Marrow

SummaryCD4+ T lymphocytes are key to immunological memory. Here we show that in the memory phase of specific immune responses, most of the memory CD4+ T lymphocytes had relocated into the bone marrow (BM) within 3–8 weeks after their generation—a process involving integrin α2. Antigen-specific memory CD4+ T lymphocytes highly expressed Ly-6C, unlike most splenic CD44hiCD62L− CD4+ T lymphocytes. In adult mice, more than 80% of Ly-6ChiCD44hiCD62L− memory CD4+ T lymphocytes were in the BM. In the BM, they associated to IL-7-expressing VCAM-1+ stroma cells. Gene expression and proliferation were downregulated, indicating a resting state. Upon challenge with antigen, they rapidly expressed cytokines and CD154 and efficiently induced the production of high-affinity antibodies by B lymphocytes. Thus, in the memory phase of immunity, memory helper T cells are maintained in BM as resting but highly reactive cells in survival niches defined by IL-7-expressing stroma cells

The ameliorative potential of Hyphaene thebaica on streptozotocin-induced diabetic nephropathy

Background: Diabetic nephropathy (DN) is the leading cause of end-stage renal disease. The aim of the current study is to investigate the possible beneficial effects of Hyphaene thebaica in DN. Materials and methods: For this, 50 male albino rats were divided into five groups: group I — represented the control group; group II — received Hyp­haene thebaica extracts of 150 mg/kg BW by oral gavage for 6 weeks; group III — received single intraperitoneal injections of streptozotocin (50 mg/kg BW) to induce type-2 diabetes mellitus; group IV (protective) — diabetic rats recei­ved Hyphaene thebaica extract (150 mg/kg BW) orally for 6 weeks; group V (curative) — received Hyphaene thebaica extract (150 mg/kg BW) orally after the diagnosis of DN. Results: In the DN protected group, blood glucose, urea, and creatinine decreased significantly, while insulin and C-peptide increased significantly. Moreover, cystatin C and neutrophil gelatinase-associated lipocalin decreased. Collagen fibre deposition is increased with an apparent thickening of the parietal layer of Bowman’s capsules and the basal lamina of convoluted tubules, as well as increase of the immune-reaction of caspase-3 and desmin. The introduction of Hyphaene thebaica led to greater amelioration in the biochemical markers, apoptotic alterations, and podocyte injuries of the protected group than in the curative group. Conclusions: Hyphaene thebaica may be advised as a good choice that can delay diabetic renal complications

IL-33 Receptor-Expressing Regulatory T Cells Are Highly Activated, Th2 Biased and Suppress CD4 T Cell Proliferation through IL-10 and TGFβ Release

Immunomodulatory Foxp3+ regulatory T cells (Tregs) form a heterogeneous population consisting of subsets with different activation states, migratory properties and suppressive functions. Recently, expression of the IL-33 receptor ST2 was shown on Tregs in inflammatory settings. Here we report that ST2 expression identifies highly activated Tregs in mice even under homeostatic conditions. ST2+ Tregs preferentially accumulate at non-lymphoid sites, likely mediated by their high expression of several chemokine receptors facilitating tissue homing. ST2+ Tregs exhibit a Th2-biased character, expressing GATA-3 and producing the Th2 cytokines IL-5 and IL-13 –especially in response to IL-33. Yet, IL-33 is dispensable for the generation and maintenance of these cells in vivo. Furthermore, ST2+ Tregs are superior to ST2− Tregs in suppressing CD4+ T cell proliferation in vitro independent of IL-33. This higher suppressive capacity is partially mediated by enhanced production and activation of the anti-inflammatory cytokines IL-10 and TGFβ. Thus, ST2 expression identifies a highly activated, strongly suppressive Treg subset preferentially located in non-lymphoid tissues. Here ST2+ Tregs may be well positioned to immediately react to IL-33 alarm signals. Their specific properties may render ST2+ Tregs useful targets for immunomodulatory therapies

A guide to best practice in faculty development for health professions schools: a qualitative analysis

BACKGROUND: This is a practice guide for the evaluation tool specifically created to objectively evaluate longitudinal faculty development programs (FDP) using the “5×2 -D backward planning faculty development model”. It was necessary to create this tool as existing evaluation methods are designed to evaluate linear faculty development models with a specific endpoint. This backward planning approach is a cyclical model without an endpoint, consisting of 5 dynamic steps that are flexible and interchangeable, therefore can be a base for an evaluation tool that is objective and takes into account all the domains of the FDP in contrast to the existing, traditional, linear evaluation tools which focus on individual aspects of the program. The developed tool will target evaluation of longitudinal faculty development programs regardless of how they were planned. METHODOLOGY: Deductive qualitative grounded theory approach was used. Evaluation questions were generated and tailored based on the 5 × 2-D model followed by 2 Delphi rounds to finalize them. Based on the finalized evaluation questions from the results of the Delphi rounds, two online focus group discussions (FGDs) were conducted to deduce the indicators, data sources and data collection method. RESULTS: Based on the suggested additions, the authors added 1 new question to domains B, with a total of 42 modifications, such as wording changes or discarding or merging questions. Some domains received no comments, therefore, were not included in round 2. For each evaluation question, authors generated indicators, data sources and data collection methods during the FGD. CONCLUSION: The methodology used to develop this tool takes into account expert opinions. Comprehensiveness of this tool makes it an ideal evaluation tool during self-evaluation or external quality assurance for longitudinal FDP. After its validation and testing, this practice guide can be used worldwide, along with the provided indicators which can be quantified and used to suit the local context. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-022-03208-x