A cause of circulatory collapse that should be considered following trauma

Management of poly-trauma patients presenting to the emergency room is usually a challenging and formidable task. Two of the common problems seen in those patients are shock and neurological dysfunction. A huge differential for post-traumatic circulatory collapse exist and timely identification of the etiology is of utmost importance to avoid complications. In this report we are describing 2 cases presenting with circulatory collapse following trauma. The first case was a 29 year old female who presented after a motor vehicle accident fully conscious with severe hypotension and bradycardia. The second case presented with severe hemodynamic instability after falling at home. Physical examination of both patients revealed weakness in all 4 limbs and CT cervical spine revealed complete anterior sublaxation of C5 over C6 cervical vertebrae in the first case and partial sublaxation of C5 over C6 cervical vertebrae in the second case confirming that spinal cord injury is the likely cause for these hemodynamic alterations. A high index of suspicion for spinal cord injuries is therefore mandatory when managing a trauma patient presenting with quadriparesis and hemodynamic instability that is otherwise unexplained especially when the ensuing hypotension is associated with bradycardia instead of reflex tachycardia. Awareness of this cause of circulatory collapse is particularly important in the unconscious patient where eliciting sensory and motor deficits looking for spinal cord injury is not always feasible. Both patients were transferred to the intensive care unit and were maintained on epinephrine till becoming hemodynamically stable. The report aims to sensitize readers to this cause of post-traumatic circulatory collapse

Lip-Listening: Mixing Senses to Understand Lips using Cross Modality Knowledge Distillation for Word-Based Models

In this work, we propose a technique to transfer speech recognition capabilities from audio speech recognition systems to visual speech recognizers, where our goal is to utilize audio data during lipreading model training. Impressive progress in the domain of speech recognition has been exhibited by audio and audio-visual systems. Nevertheless, there is still much to be explored with regards to visual speech recognition systems due to the visual ambiguity of some phonemes. To this end, the development of visual speech recognition models is crucial given the instability of audio models. The main contributions of this work are i) building on recent state-of-the-art word-based lipreading models by integrating sequence-level and frame-level Knowledge Distillation (KD) to their systems; ii) leveraging audio data during training visual models, a feat which has not been utilized in prior word-based work; iii) proposing the Gaussian-shaped averaging in frame-level KD, as an efficient technique that aids the model in distilling knowledge at the sequence model encoder. This work proposes a novel and competitive architecture for lip-reading, as we demonstrate a noticeable improvement in performance, setting a new benchmark equals to 88.64% on the LRW dataset.Comment: arXiv admin note: text overlap with arXiv:2108.0354

Framework of performance measurement practices in construction companies in Egypt

© 2018 Sciendo. All rights reserved. Construction industry is considered as one of the most important sectors in Egypt. One of the major challenges faced by the industry, however, is the unavailability of suitable performance measurement systems for assessing companies' performance. Modern performance assessment systems adopt a more universal approach to the measurement of construction company performance as opposed to the traditional project triangle. This paper aims to examine the practice of performance measurement in the Egyptian construction industry. Results show dominant role of in-house developed performance management systems as well as the use of KPIs as a method of performance assessment. The study further reveals that the highest importance is given to measures related to the time of project delivery, quality of works, clients' satisfaction and profitability. Hence, the traditional project triangle of project's success is the most prevalent approach to performance evaluation in the construction industry in Egypt. However, a shift towards a more holistic approach to performance assessment in larger companies was observed

Chronic pain in hemodialysis patients: Role of bone mineral metabolism

Background: Pain is one of the most common complaints in clinical practice because it is a symptom for a myriad of physical and mental problems. The high prevalence of pain in the chronic kidney disease (CKD) population is particularly concerning because pain has been shown to adversely affect quality of life. The aim of this study was to evaluate the prevalence and possible causes of chronic pain in patients with end stage renal disease on long-term hemodialysis (HD).Methods: We prospectively enrolled 100 patients who were undergoing maintenance HD for at least 6 months or more. Pain was evaluated using the Brief Pain Inventory (BPI). Data collected on each participant included age, gender, body mass index (BMI), time on dialysis and biochemical findings.Results: The average age was 42.06 years ranged from 22 to 58 years; the average duration on dialysis was 4.97 years. 52 patients were males and 48 were females. Although 52% of patients experienced chronic pain, only 25% described the pain as severe, 28% described pain as moderate while 52% of patients described as mild. Musculoskeletal pain was the most frequent form of chronic pain reported by patients who were on HD (54%). Malnutrition and high CRP were highly statistically associated with chronic pain (p< 0.001). High statistical significant correlation was found between lower calcium, lower 25(OH) D3 levels, higher parathyroid hormone (PTH) levels and experienced chronic pain (p< 0.001).Conclusion: Chronic pain is highly experienced in long-term hemodialysis patients. Malnutrition, high CRP and disturbed bone mineral metabolism are highly correlated with the incident of this pain

Occult pneumothorax, revisited

Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving. In cases of trauma patients where cervical spine immobilization is mandatory, supine AP chest radiograph is the most practical initial study. It is however not as sensitive as CT chest for early detection of a pneumothorax. "Occult" pneumothorax is an accepted definition of an existing but usually a clinically and radiologically silent disturbance that in most patients can be tolerated while other more urgent trauma needs are attended to. However, in certain patients, especially those on mechanical ventilation (with subsequent increase of intrapleural air with positive pressure ventilation), missing the diagnosis of pneumothorax can be deleterious with fatal consequences. This review will discuss the occult pneumothorax in the context of 3 radiological examples, which will further emphasize the entity. Because a negative AP chest radiograph can dangerously delay its recognition, we recommend that any trauma victim presenting to the emergency department with symptoms of respiratory distress should be screened with either thoracic ultrasonography or chest CT scan to avoid missing a pneumothorax

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management

Bacteriophage ZCSE2 is a Potent Antimicrobial against Salmonella enterica Serovars: Ultrastructure, genomics and efficacy

© 2020 by the authors. Developing novel antimicrobials capable of controlling multidrug-resistant bacterial pathogens is essential to restrict the use of antibiotics. Bacteriophages (phages) constitute a major resource that can be harnessed as an alternative to traditional antimicrobial therapies. Phage ZCSE2 was isolated among several others from raw sewage but was distinguished by broad-spectrum activity against Salmonella serovars considered pathogenic to humans and animals. Lytic profiles of ZCSE2 against a panel of Salmonella were determined together with low temperature activity and pH stability. The morphological features of the phage and host infection processes were characterized using a combination of transmission electron and atomic force microscopies. Whole genome sequencing of ZCSE2 produced a complete DNA sequence of 53,965 bp. No known virulence genes were identified in the sequence data, making ZCSE2 a good candidate for phage-mediated biological control purposes. ZCSE2 was further tested against S. Enteritidis in liquid culture and was observed to reduce the target bacterium to below the limits of detection from initial concentrations of 107–108 Colony Forming Units (CFU)/mL. With a broad host-range against pathogenic Salmonella serovars, phage ZCSE2 constitutes a potential tool against a major cause of human and animal disease

Potential molluscicidal activity of the aqueous extracts of some plants and their powders against terrestrial snail Monacha obstructa (L. Pfeiffer, 1842) under laboratory and field conditions

As it is known that the excessive use of pesticides causes many environmental problems, the effects of four aqueous plant extracts and their powders [Solanum nigrum L., Withania somnifera (L.) Dunal, Salix mucronata Thunb. and Lawsonia inermis L.] were evaluated as natural molluscicides on the land snail Monacha obstructa (Family: Hygromiidae) under laboratory conditions. Three different bioassay methods were used: contact, leaf-dipping and bait techniques. The results indicated that, using all methods, S. Nigrum extract was the most toxic extract for the terrestrial snail M. obstructa. The contact technique of the tested plant extracts was the most effective method of application compared to other methods. Moreover, using plant extracts was better than using powders of these plants for controlling the terrestrial snail M. obstructa. In addition, the results indicated that the aqueous extract of S. nigrum gave the highest percentage of reduction in the snail population when assessed under field conditions. The obtained data showed that plant extracts were significantly effective against the terrestrial snail and could be used as alternatives to pesticides in integrated pest management

Geotechnical aspects of alluvial soils at different depths under sodium chloride action in Najran region, Saudi Arabia: Field supported by laboratory tests

The current research study is aimed at studying the impact of sodium chloride on the performance of semi-arid soils in the Najran area of Saudi Arabia. Experimental work has been undertaken to investigate how adding salt to the semi-arid soil collected in the Najran area affects the boundaries of Atterberg, compaction characteristics, California bearing ratio, and shear strength. All testing was conducted on soil samples from different zones of the Najran area at varying depths of 1.5, 3, and 4.5 m along the soil profiles. The soil samples were analyzed individually and then compared with the same soil samples mixed with NaCl at different percentages of 5, 10, and 20% by weight of the dry soil. Using advanced techniques, such as the scanning electron microscope, energy dispersive x-ray analysis, and X-ray diffraction analysis, the stabilization process was examined. The findings revealed that NaCl significantly impacts the geotechnical characteristics of semi-arid soils. The maximum dry density increased from 1.995, 1.93, and 1.96 to 2.02, 1.99, and 2.03 g/cm3, and the optimal water content decreased from 9.47, 13.7, and 11.29 to 7.01, 9.58%, and 8.09% with 20% NaCl added at various depths, respectively. Shear resistance parameters were improved by adding 20% NaCl, where the soil cohesion increased from 0.1333, 0.0872, and 0.0533 to 0.1843, 0.1034, and 0.0372 kg/cm2, and the angle of internal friction increased from 24°, 25.5°, and 29° to 27.8°, 30°, and 33°, respectively. The liquid and plastic limits and, in turn, the plasticity index reduced as the added percentage of NaCl increased. Furthermore, the California bearing ratio percentages significantly increased and reached more than 50%. As a result, it is established that NaCl is an excellent stabilizer, especially at 20% concentration, and might be used as a sub-base substance in highway construction

A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies

Background: The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. Methods: A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. Results: A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. Conclusions: Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.This article was made possible by the National Priorities Research Program-Standard (NPRP-S) Twelfth (12th) Cycle grant# NPRP12S-0219-190108, from the Qatar National Research Fund (a member of Qatar Foundation)