Investigation of simple portable telescope validity for muon detection inside metals

Muons produced in the atmosphere by cosmic rays are preferred over gamma rays, X-rays and fast protons for the detection of metals in the study of radiography. An alternative method for metals detection involving portable and relatively cheap Geiger-Muller counters are proposed. The objective of this study was to investigate the validity of using a handmade muon telescope with a small solid angle for the detection of muons inside the metals. This experiment was carried out at Universiti Kebangsaan Malaysia, Bangi (101.78º E, 2.92º N and elevation 30 m). Measurement of muons was conducted in the vertical direction using 1 set of muon telescopes (MT) consisting of coaxial Geiger-Muller (GM) counters. Different metals - lead (Pb), zinc (Zn) and aluminium (Al) - were used as absorbers with different thickness to observe its influence on the count rate of muons. The efficiency of the experimental setup was evaluated using statistical methods and by obtaining sufficient number of muon detection events to describe the physics of the muon interaction with the metals. Based on the Rossi curve obtained for each metal, the transition point was estimated as follows: 1.5 cm for Pb, 4.0 cm for Zn, and 9.0 cm for Al. The results showed that the proposed alternative setup was adequate for detecting muons and therefore have the potential to be further developed

Heat Stroke in Emergency Department: Diagnosis and Management

Background: Heat stroke is a severe health concern with the potential for multi-organ failure, necessitating rapid and effective management. With rising global temperatures, there is increasing concern regarding the vulnerability of populations in high-heat areas, notably in Saudi Arabia, especially during the annual Hajj pilgrimage. Objective: This paper aims to review the epidemiology, evaluation and management techniques of heat stroke, emphasizing the situation during Hajj pilgrimages in Saudi Arabia, and to outline the best practices for emergency management. Methodology: A comprehensive review of literature and studies related to heat stroke, both globally and specific to Saudi Arabia, was undertaken. An in-depth analysis of emergency management, including initial assessment, cooling methods, organ support, medication, and prevention strategies, was conducted. Results: Heat stroke remains a significant cause of emergency department visits, with specific groups, such as men and the elderly, being more susceptible. During the Hajj in 2016, 267 patients were diagnosed with heat-related illnesses, with heatstroke accounting for 29% of these cases. With the threat of global warming, studies indicate a potential tenfold increase in heat stroke risk with a 2°C rise in temperatures. Swift and comprehensive cooling is pivotal for recovery. Management emphasizes rapid recognition, assessment, and varied cooling methods, along with targeted treatments for organ dysfunctions. Prevention strategies play a vital role, given the higher efficacy and practicality over treating organ dysfunctions. Conclusion: Heat stroke is a pressing health challenge, particularly in high-risk environments like Saudi Arabia during the Hajj pilgrimage. While effective emergency management protocols exist, an emphasis on prevention is crucial. It is imperative to incorporate a comprehensive approach to address both the immediate threat and long-term risks of heat stroke, especially with the looming challenge of global warming

Overview on Blood Transfusion-Transmitted Diseases

As it is important for the Blood transfusion to be extremely safe, some measures have to be taken long safeguarded the blood supply from the major transfusion transmissible diseases (TTIs).  The risk of transfusion-transmitted infection (TTI) rises with the number of donors exposed, and the effects of TTI are frequently more severe in immune compromised people. TTIs (hepatitis B virus [HBV], HIV, and hepatitis C virus [HCV]) are examples of typical transfusion-transmitted infectious agents. As a result of the gradual application of nucleic acid-amplification technology (NAT) screening for HIV, HCV, and HBV, the residual risk of infected window-period donations has been minimized. Nonetheless, infections emerge far more frequently than is commonly acknowledged, needing ongoing surveillance and individual assessment of transfusion-associated risk. Although there is a constant need to monitor present dangers owing to established TTI, the ongoing issues in blood safety are mostly related to surveillance for developing agents, as well as the creation of quick reaction systems when such agents are detected

Role of Nemolizumab and Omalizumab in management of atopic dermatitis: A review

BackgroundNemolizumab (CIM331) is a monoclonal antibody that binds the IL-31 receptor α component. This inhibits IL-31 from acting on neurons that constrains the initialization of the sense of pruritus in cases of atopic dermatitis.AimsTo summarize the results of reported studies evaluating the role of nemolizumab and omalizumab in management of atopic dermatitis.Methods This is a systematic review was carried out, including PubMed, Google Scholar, and EBSCO that examining randomized controlled trials, observational, and experimental studies which study role of nemolizumab in management of atopic dermatitis.Results The review included 8 randomized studies reported efficacy of both nemolizumab and omalizumab for management of atopic dermatitis.ConclusionOther studies with large numbers of patients with AD are necessary to define the adverse effects of both drugs in the treatment of AD

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Coronary Artery Bypass grafting (CABG) versus Percutaneous Coronary Intervention (PCI) in the treatment of multivessel coronary disease

BackgroundRevascularization for patients who suffer multivessel coronary artery disease is a common procedure around the world. Taking United about 700,000 patients have multivessel coronary revascularization per year ¼ of these patients are diagnosed with diabetes. AimsTo summarize the current evidence that compare CABG to PCI in multivessel coronary disease‎ in form of ‎cardiac death, stroke, MI and unplanned devascularization.‎Methods This is a systematic review was carried out, including PubMed, Google Scholar, and EBSCO that examining randomized trials of treatment of multivessel coronary disease to summarize the major RCT concerning this topic.Results The review included five randomized studies that compare coronary artery bypass grafting and percutaneous coronary intervention. The findings showed that CABG show better result with less mortality rate.ConclusionThis review concluded that there revascularization in treating coronary artery disease could be conducted either by CABG or PCI, CABG show better result as it cause less death, MI and revascularization rates, but the usage of new additions such as second generation DES, can also improve the safety and efficacy of PCI when added to it

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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global patterns in endemicity and vulnerability of soil fungi

Fungi are highly diverse organisms, which provide multiple ecosystem services. However, compared with charismatic animals and plants, the distribution patterns and conservation needs of fungi have been little explored. Here, we examined endemicity patterns, global change vulnerability and conservation priority areas for functional groups of soil fungi based on six global surveys using a high-resolution, long-read metabarcoding approach. We found that the endemicity of all fungi and most functional groups peaks in tropical habitats, including Amazonia, Yucatan, West-Central Africa, Sri Lanka, and New Caledonia, with a negligible island effect compared with plants and animals. We also found that fungi are predominantly vulnerable to drought, heat and land-cover change, particularly in dry tropical regions with high human population density. Fungal conservation areas of highest priority include herbaceous wetlands, tropical forests, and woodlands. We stress that more attention should be focused on the conservation of fungi, especially root symbiotic arbuscular mycorrhizal and ectomycorrhizal fungi in tropical regions as well as unicellular early-diverging groups and macrofungi in general. Given the low overlap between the endemicity of fungi and macroorganisms, but high conservation needs in both groups, detailed analyses on distribution and conservation requirements are warranted for other microorganisms and soil organisms

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112