Type of High Secondary School (Governmental Vs Private) and Type of High Secondary School Certificate (Sudanese Vs Arabian): Do They Affect Learning Style?

Background: People differ in the way they perceive, process, store, and recall what they are attempting to learn. This study aimed to assess the learning styles among preclinical 1st year medical students and the influence of the type of high secondary school (governmental vs. private) and type of high secondary school certificate (Sudanese vs. Arabian) on learning style.Materials and Methods: A cross sectional institutional-based study was conducted at Al Neelain University, Khartoum State, Sudan. First year students of Medicine, Dentistry and Physiotherapy Faculties were enrolled. The VARK (Visual, Auditory, Read and write, and Kinesthetic) learning style hard copy questionnaire, © Copyright Version 7.8 (2014) held by VARK Learn Limited, Christchurch, New Zealand was administered following permission. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21.Results: Out of 320 students, 198 correctly completed VARK questionnaires, with mean age of 17.88 years (SD 1.52) and 74.2% were female students. About 59.6% were from governmental schools and 79.4% of the studied students had Sudanese High Secondary Certificates. About 64.1% demonstrated singular mode preference. Inferential statistics showed statistically significant difference between the learning styles and the type of secondary school whether governmental or private (P-value 0.005) while no statistically significant difference in relation to the type of high school certificate of the studied group (P-value 0.225).Conclusion: The type of secondary school whether governmental or private may affect learning style of medical students while student's gender, type of college, or type of high school certificate (whether Sudanese or Arabian) do not. More andlarger studies are encouraged.Key word: Learning modalities, VARK questionnaire, Unimodal preference, Medicaleducation, Sudan

Urinary iodine level assessment during third trimester in a sample of Egyptian pregnant women and its relation to thyroid function

Background: Inadequate intakes of iodine during pregnancy may cause thyroid dysfunctions that adversely affect pregnancy outcomes. Aim of the work was to evaluate the urinary iodine level as a marker of iodine status in a sample of Egyptian pregnant women during 3rd trimester and assess its relation to thyroid functions.Methods: This cross-sectional study was conducted on 100 pregnant females at their 3rd trimester aged (18-35) years. They were divided according to their urinary iodine concentration into 3 groups; Group (I): Pregnant females with deficient iodine (<150 μg/l), Group (II): Pregnant females with adequate iodine (150-249) μg/l, Group (III): pregnant females including who have above requirements (250-499 μg/l), and excessive (≥500 μg/l). TSH, free t4, free t3, Anti-Thyroglobulin (TgAb) and anti-thyroid perioxidase (TPOAb), medium urinary Iodine concentration (UIC) by ELISA and neck U/S were performed to all participants.Results: 18% of the pregnant women in our study had iodine deficiency during 3rd trimester (UIC<150 ug/l) whereas 55% of pregnant women had excess iodine level, and adequate iodine level was observed in 27%.  Serum TSH was significantly higher in group I with deficient iodine level (p value<0.01). All pregnant women included at group I were suffering from subclinical hypothyroidism. Serum TSH and thyroid volume were inversely correlated with urinary iodine among pregnant females at 3rd trimester (p value<0.01).Conclusions: Serum TSH and thyroid volume were inversely correlated with urinary iodine level among pregnant females at 3rd trimester

Three-Dimensional Power Doppler Evaluation of Adnexal Masses. Which Parameter Performs Best?

Objective:To evaluate the role of 3D power Doppler in assessment of adnexal masses vascularity, its ability to discriminate benign from malignant adnexal masses. Then, to determine which one of the 3D power Doppler parameters has the highest reliability for detection of adnexal malignancy.Materials and Methods:A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Woman’s Health Center, Assiut University, Egypt between October 2012 and October 2013. All patients were evaluated by 3-DPD ultrasound for assessement of tumor vascularization with calculation of vascular indices using Virtual organ computer-aided analysis program. A definitive histopathological diagnosis was obtained in every case to be used as a gold standard.Results:One hundred sixty-one patients were recruited, 115 with benign masses, 46 with malignant masses. The mean vascularization index (16.36 versus 10.98; p<0.05), and the mean vascularization-flow index (3.91 versus 2.13; p<0.01) were significantly higher in malignant tumors. No significant difference was found in the mean flow index. Chaotic architecture of vessels was significantly associated with malignancy (80.4% versus 6.1%; p<0.001) than benign possibility of masses. Also, complex branching pattern of vessels was more significantly present in malignant masses than benign ones (47.8% versus 4.3%; p<0.001). 3D power Doppler had a sensitivity of 80%, specificity of 94%, PPV of 84% and NPV of 92% in detection of malignant adnexal masses.Conclusion:Careful evaluation of the architectiure of vessels was the best parameter in evaluation of the masses with 3D power Doppler. Evaluation of branching pattern had a low sensitivity and specificity in detection of malignancy. In spite of no clear cut-off values for vascular indices to be accurate in differentiation of adnexal masses, higher values of vascularization index and vascularization-flow index were strongly associated with adnexal malignancy

Evaluation of adnexal masses by Three-Dimensional ultrasound multi-slice view: Do we really need it?

Objective:The purpose of this study is to evaluate the benefit of use of three-dimensional ultrasound multi-slice view in detailed assessment of adnexal masses morphology. Methods:Two-hundred thirty one patients with adnexal masses elected for surgery at Woman’s Health Center, Assiut, Egypt between October 2012 and October 2013 were recruited for the study. Each patient had 2D ultrasound and detailed morphological evaluation was reported. Then, 3D ultrasound volumes were obtained. The stored 3D volumes were then digitally analyzed using 3D ultrasound multi-slice view. The results of 2D, 3D ultrasound multi-slice were compared to the postoperative histopathological findings.Results:The mean age of included patients was 30.2 ± 12.7 years. Overall, 189 patients (81.8%) confirmed to have benign masses, and 42 patients (18.2%) with malignant masses according to their final histopathological analysis. Subjective assessment by 2D ultrasound correctly classified 95.6% of benign masses and 87% of malignant masses. On detailed assessment of the masses by 3D ultrasound multi-slice view, there was agreement in morphological assessment of all masses except in 3 cases in which 3D ultrasound multi-slice view permitted better description of their morphological criteria and hence changing the presumed diagnosis and management.Conclusions: The ability of detailed analysis of the volumes taken during 3D ultrasound using multi-slice view can aid in better morphological assessment of adnexal masses especially in detection of papillary projections in adnexal cysts. This information is valuable in deciding the optimal management of adnexal masses in some cases

Improving the mechanical behavior of pervious concrete using polypropylene and waste rope fibers

Urbanization has led to the damage of infrastructure due to floods and water accumulation on roads and sidewalks. To address this problem, pervious concrete was designed to drain water smoothly. However, pervious concrete has certain drawbacks, such as brittleness and poor tensile strength. To overcome these shortcomings, it is reinforced with fiber. Polypropylene fibers are commonly used for this purpose. On the other hand, managing waste plastic is a major problem as it has a significant environmental impact and requires large areas for landfills. Waste rope fibers (WRF) are among these wastes. There have been very limited investigations on the use of WRF in pervious concrete. Therefore, this study aims to investigate the effect of polypropylene (PP) fibers and waste rope fibers (WRF) on the mechanical and structural properties of pervious concrete. PP and WRF fibers were added in proportions of 0.25%, 0.5%, and 0.75% by volume of concrete. A range of tests (compressive strength, tensile strength, density, permeability, load-deflection behavior, and ductility) were conducted to evaluate the resulting concrete. The results indicated that although the permeability was decreased by adding fibers, the fibers significantly improved the mechanical and structural properties of pervious concrete. The highest values for compressive strength, splitting tensile strength, and ultimate load were 83.4%, 72.4%, and 89.62% for PP fibers-based mixtures, while they were 49.9%, 41.9%, and 102.83% for mixtures made with WRF at an addition rate of 0.5% for both types of fibers. The results also demonstrated that the existence of fibers improved the ductility of the concrete, which means that WRF can be used successfully in producing eco-friendly pervious concrete with better performance than the control specimen.</jats:p

Fabrication of Tm2O3/Al2O3-silica preform by improved MCVD-chelate delivery system

The fabrication of Tm/Al-doped silica preforms by an improved MCVD method with metal chelate precursors is discussed. Two fabrication techniques are employed, namely; simultaneous soot-dopant deposition (or standard MCVD) and stepwise soot-dopant deposition. The preforms are characterized by refractive index profiler and EPMA. The results show that the stepwise soot-dopant technique has a higher incorporation of Al2O3 and Tm2O3 as compared to the simultaneous soot-dopant method. This is due to the drawbacks of our chelate delivery system such as the temperature gradient and flow design. For the stepwise technique, the measured index difference of the preform is 0.006 with 0.8 wt% (maximum) Tm incorporated in the core

Medical prospects of cryptosporidiosis in vivo control using biofabricated nanoparticles loaded with Cinnamomum camphora extracts by Ulva fasciata

Background and Aim: Global efforts are continuing to develop preparations against cryptosporidiosis. This study aimed to investigate the efficacy of biosynthesized Ulva fasciata loading Cinnamomum camphora oil extract on new zinc oxide nanoparticles (ZnONPs shorten to ZnNPs) and silver nanoparticles (AgNPs) as alternative treatments for Cryptosporidium parvum experimental infection in rats. Materials and Methods: Oil extract was characterized by gas chromatography-mass spectrometry, loaded by U. fasciata on ionic-based ZnO and NPs, and then characterized by transmission electron microscopy, scanning electron microscopy, and X-ray diffraction. Biosafety and toxicity were investigated by skin tests. A total of 105 C. parvum oocysts/rat were used (n = 81, 2–3 W, 80–120 g, 9 male rats/group). Oocysts shedding was counted for 21 d. Doses of each preparation in addition to reference drug were administered daily for 7 d, starting on post-infection (PI) day (3). Nitazoxanide (100 mg) was used as the reference drug. After 3 weeks, the rats were sacrificed for postmortem examination and histopathological examination. Two blood samples/rat/group were collected on the 21st day. Ethylenediaminetetraacetic acid blood samples were also used for analysis of biochemistry, hematology, immunology, micronucleus prevalence, and chromosomal abnormalities. Results: C. camphora leaves yielded 28.5 ± 0.3 g/kg oil and 20 phycocompounds were identified. Spherical and rod-shaped particles were detected at 10.47–30.98 nm and 18.83–38.39 nm, respectively. ZnNPs showed the earliest anti-cryptosporidiosis effect during 7–17 d PI. Other hematological, biochemical, immunological, histological, and genotoxicity parameters were significantly fruitful; hence, normalized pathological changes induced by infestation were observed in the NPs treatments groups against the infestation-free and Nitazoxanide treated group. Conclusion: C. camphora, U. fasciata, ZnNPs, and AgNPs have refluxed the pathological effects of infection as well as positively improved host physiological condition by its anticryptosporidial immunostimulant regenerative effects with sufficient ecofriendly properties to be proposed as an alternative to traditional drugs, especially in individuals with medical reactions against chemical commercial drugs

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

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

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