Prevalence of Prediabetes in Patients with Acute Coronary Syndrome and Its Relation to In-Hospital Clinical Outcome

Background: Diabetes mellitus is one of the leading causes of vascular disease. The caseload is expected to reach 350 million by the year 2030, and it is estimated that up to 30% of patients are undiagnosed. Objective: The aim of the study was to explore the prevalence of prediabetes in patients admitted with acute coronary syndromes (ACS) who were not known to have diabetes and to determine the impact of prediabetes on in-hospital clinical outcomes versus non-diabetic patients. Patients and methods: This prospective study was conducted on 60 patients with acute coronary syndrome who were admitted to the intensive care unit (ICU), Internal Medicine Department, Faculty of Medicine, Zagazig University during the period from September 2019 to March 2020. All studied subjects were subjected to full history taking complete clinical examination, complete blood count, glycosylated haemoglobin (HbA1c), lipid profile, serum creatinine and oral glucose tolerance test (OGTT), ECG and ECHO. Results: There was a statistical significant difference between the studied groups regarding acute coronary syndrome types, glycated haemoglobin (HbA1c), serum creatinine, and high-density lipoproteins cholesterol. There was statistically significant difference between the studied patients grouped according to the clinical outcome regarding ACS types. Conclusion: Prediabetes is common in patients presenting with acute coronary syndrome who are not previously known to have diabetes. Pre-diabetic patients had worse in-hospital clinical outcomes compared with patients without diabetes. Pre-diabetic patients with ACS have greater  prevalence of cardio-metabolic risk factors (abdominal obesity, and hypertension) as compared to non-diabetic patients

Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Implementation of a steganography system based on hybrid square quaternion moment compression in IoMT

Internet of Medical Things (IoMT) systems generate medical data transmissions between patients, medical experts, and medical centers over public networks, which require high levels of security to protect the content of medical images and the personal information they contain. In this paper, we propose a new stego image encryption scheme based on a new secret image compression method, wavelet transformation, QR decomposition of the cover image, and a new chaotic map. The secret image is compressed by the Hahn-Krawtchouk hybrid quaternion square moments (HK-HQSM), which are optimized by a new hybrid metaheuristic algorithm based on the Salp Swarm Algorithm (SSA) and the Arithmetic Optimization Algorithm (AOA). To increase the security level when transmitting the proposed stego images over public networks, we introduce a new chaotic map based on the 2D fractional Henon map to encrypt the stego image. To demonstrate the effectiveness of the proposed steganography scheme for IoMT, we implemented this scheme on a low-cost Raspberry Pi 4 hardware board. The results of the performed numerical experiments show that our method is secure and provides exceptional robustness against common standard image processing attacks (steganalysis attacks). The results also demonstrate that our strategy is able to work efficiently and quickly when implemented on a Raspberry Pi board

Optimal algorithm for color medical encryption and compression images based on DNA coding and a hyperchaotic system in the moments

Currently, visual data security plays a significant role in various fields, especially in medical imaging. Addressing the challenges associated with limited key space and vulnerability to different types of attacks within current encryption schemes, this work proposes an optimal compression-encryption scheme for large medical images that incorporates elements of Archimedes' optimization algorithm, discrete orthogonal Hahn moments, chaotic systems, and DNA coding. The primary aim of this study is to develop an optimal and exceptionally resilient compression-encryption scheme capable of countering various attack types effectively. This approach is structured into three principal phases: a compression phase harnessing the efficiencies of Hahn's discrete orthogonal moments (HMs) in signal and image representation, coupled with the Archimedes optimization algorithm (AO) to ensure optimal tuning of polynomial parameters (a, b) for superior image reconstruction quality. The encryption phase is performed on the compressed image, using hyperchaotic memristive 4-D (HCM-4D), adapted logistics map (ALM) and DNA coding. Initially, the adapted logistics map is responsible for generating random sequences linked to the compressed image. Subsequently, chaotic sequences originating from the hyperchaotic 4-D memristive system govern both random sequences and DNA processes. The optimization phase, facilitated by the AO algorithm, focuses on minimizing the value of the objective function (correlation) on the compressed and encrypted images. Ultimately, the image with the lowest correlation value is designated as the optimal compressed-encrypted representation.The simulation results clearly illustrate the resilience of the AO algorithm when juxtaposed with other optimization algorithms, especially with respect to convergence speed and computational efficiency. On the other hand, the proposed compression approach demonstrated exceptional efficiency in compressing medical images, offering us the possibility to achieve impressive compression ratio (CR) as well as exceptional quality in decompressed images, evident thanks to high PSNR values. In addition, security analyze demonstrate that the proposed compression-encryption benefits from a larger key space and superior resistance against different types of attacks. Furthermore, our approach was subjected to a comparative analysis alongside various encryption method. These comparisons demonstrate that our encryption algorithm surpasses others in terms of both security and effectiveness