The Egyptian Arabic version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR)

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient-reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Egyptian Arabic language. The reading comprehension of the questionnaire was tested in ten JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach\u2019s alpha, interscale correlations, test\u2013retest reliability, and construct validity (convergent and discriminant validity). A total of 100 JIA patients (20.0% systemic JIA, 40.0% undifferentiated arthritis, 24.0% RF negative polyarthritis, 16.0% other categories) and 100 healthy children were enrolled in one paediatric rheumatology centre. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed satisfactory psychometric performances. In conclusion, the Egyptian Arabic version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and in clinical research

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

Abstract 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

Comparing the Use of Modern and Traditional Building Design Systems in Construction Projects

Any construction project through several stages, starting from the feasibilitystudy stage to the project delivery stage, as the most critical stage that must be focused on is the design stage. It was essential to adopt modern and advanced programs at the design stage to avoid problems and claims between the employer and the contractor due to changes and errors that occur in the project—design process. BIM is one of the modern technologies with many benefits that can be used to solve these errors and obstacles. This research aims to clarify the effectiveness of introducing the BIM system in the design stage of the construction building by comparing it with traditional CAD systems. In this research, ten different actual projects were studied in the architectural design stage to be used in the comparison process between BIM and CAD systems. The researcher reached a set of results, including that introducing the (BIM) in the architectural and structural design stage can reduce the time required to produce design documents by up to (67.6%). This study is helpful for all governmental and private design companies and encourages decision-makers to use the BIM system

A 5-year registry of mechanically ventilated patients comprising epidemiology, initial settings, and clinical outcome

Introduction Our primary aim was to document our interactions with patients subjected to mechanical ventilation (MV) in the Critical Care Department focusing on epidemiological characteristics; the initial modes of ventilation used, and initial settings. Our secondary aim was to document final clinical outcomes of MV, including length of stay, weaning, complications, and hospital mortality. Patients and methods Patients’ data were collected retrospectively from January 2010 to December 2014 (5 years) through reviewing an electronic database (Medica Plus). Results We enrolled a total of 1081 patients. The duration of ventilation was 6±10 days, and length of ICU stay was 13±15 days. The predominant indications of ventilation were cardiac diseases followed by respiratory diseases, neurological diseases, sepsis, and septic shock. Volume controlled ventilation was the most common initial mode of ventilation followed by Non Invasive Continuous Positive Airway Pressure – Pressure Support (NICPAP-PS) and pressure controlled ventilation. Noninvasive ventilation was associated with shorter duration on MV and ICU stay. Pressure Support – Continuous Positive Airway Pressure (PS-CPAP) was the most common weaning mode used followed by unplanned extubation, Non Invasive Continuous Positive Airway Pressure (NICPAP), T-piece, and sencronized intermittent mandatory ventilation. Highest rate of successful weaning was in patients with central nervous system diseases followed by respiratory diseases, cardiac diseases, and least in patients with sepsis and septic shock. Mortality rate in mechanically ventilated patients was 64%. Mortality rate was higher in patients with cardiac diseases followed by respiratory diseases, central nervous system diseases, and septic shock. Mortality was higher with higher levels of tidal volumes, higher FiO2 levels, and lower positive end-expiratory pressure levels. Mortality was higher in invasive ventilation than noninvasive ventilation. Patients with failed weaning had higher mortality. Conclusions We have demonstrated the magnitude of MV use in our ICU, the epidemiology and initial ventilation modes used, and their association with complications and in-hospital mortality

Combined microbiological and clinical outcomes of short-term inhaled colistin adjunctive therapy in ventilator-associated pneumonia

Purpose Aerosolized antibiotics have potential lower risks of toxicity. Colistin has an excellent bactericidal activity against most gram-negative bacilli. We aimed to define both microbiological and clinical target outcomes after a 5-day treatment period in the treatment of patients with gram-negative ventilator-associated pneumonia (VAP). Patients and methods We recruited all patients with gram-negative bacteria culture and sensitivity taken from endotracheal tube aspirates after greater than or equal to 48 h of mechanical ventilation and clinical pulmonary infection score (CPIS) greater than or equal to 6. Patients were randomized to enter either the study group of inhaled colistin (3 million IU/day, for 5 days) as an adjunctive therapy to intravenous antibiotic treatment of VAP or enter the control group of intravenous antibiotics only. In both arms, intravenous antibiotics were started from the day of clinical suspicion according to American Thoracic Society/Infectious Disease Society of America guidelines. Interpretations on day 6 included microbiological outcome (endotracheal tube aspirate culture and sensitivity) and CPIS. Favorable outcome was defined if there was a microbiological clearance and CPIS less than 6. Patients were monitored for bronchospasm, daily serum creatinine, days of mechanical ventilation, and 30-day mortality. Results A total of 102 patients were recruited. Colistin group included 52 patients and the control group included 50 patients. Favorable outcome was higher [41 (78.8%) vs. 27 (54%), P=0.02] in colistin versus control group, respectively. Prolonged mechanical ventilation for more than 15 days was lower [23 (44.2%) vs. 44 (88%), P=0.01] and a 30-day hospital mortality was lower [21/52 (40.3%) vs. 35/50 (70%), P=0.008] in colistin versus control group, respectively. Conclusion Five days of adjunctive inhaled colistin in patients with gram-negative VAP showed a higher combined clearance and clinical improvement, including multidrug resistant groups, decreased duration of mechanical ventilation, and ICU mortality when compared with conventional intravenous therapy alone

The potential ameliorative impacts of cerium oxide nanoparticles against fipronil-induced hepatic steatosis

Abstract Fipronil (FIP) is a phenylpyrazole insecticide that is commonly used in agricultural and veterinary fields for controlling a wide range of insects, but it is a strong environmentally toxic substance. Exposure to FIP has been reported to increase the hepatic fat accumulation through altered lipid metabolism, which ultimately can contribute to nonalcoholic fatty liver disease (NAFLD) development. The present study aimed to examine the function of cerium oxide nanoparticles (CeNPs) in protecting against hepatotoxicity and lipogenesis induced by FIP. Twenty-eight male albino rats were classified into four groups: FIP (5 mg/kg/day per os), CTR, CeNPs (35 mg/kg/day p.o.), and FIP + CeNPs (5 (FIP) + 35 (CeNPs) mg/kg/day p.o.) for 28 consecutive days. Serum lipid profiles, hepatic antioxidant parameters and pathology, and mRNA expression of adipocytokines were assessed. The results revealed that FIP increased cholesterol, height-density lipoprotein, triacylglyceride, low-density lipoprotein (LDL-c), and very-low-density lipoprotein (VLDL-c) concentrations. It also increased nitric oxide (NO) and malondialdehyde (MDA) hepatic levels and reduced glutathione peroxidase (GPx) and superoxide dismutase (SOD) enzyme activities. Additionally, FIP up-regulated the fatty acid-binding protein (FABP), acetyl Co-A carboxylase (ACC1), and peroxisome proliferator-activated receptor-alpha (PPAR-α). Immunohistochemically, a strong proliferation of cell nuclear antigen (PCNA), ionized calcium-binding adapter molecule 1 (Iba-1), cyclooxygenase-2 (COX-2) reactions in the endothelial cells of the hepatic sinusoids, and increased expression of caspase3 were observed following FIP intoxication. FIP also caused histological changes in hepatic tissue. The CeNPs counteracted the hepatotoxic effect of FIP exposure. So, this study recorded an ameliorative effect of CeNPs against FIP-induced hepatotoxicity

Chemo-Protective Potential of Cerium Oxide Nanoparticles against Fipronil-Induced Oxidative Stress, Apoptosis, Inflammation and Reproductive Dysfunction in Male White Albino Rats

Fipronil (FIP) is an insecticide commonly used in many fields, such as agriculture, veterinary medicine, and public health, and recently it has been proposed as a potential endocrine disrupter. The purpose of this study was to inspect the reproductive impacts of FIP and the possible protective effects of cerium nanoparticles (CeNPs) on male albino rats. Rats received FIP (5 mg/kg bwt; 1/20 LD50), CeNPs (35 mg/kg bwt) and FIP+CeNPs per os daily for 28 days. Serum testosterone levels, testicular oxidative damage, histopathological and immunohistochemical changes were evaluated. FIP provoked testicular oxidative damage as indicated by decreased serum testosterone (≈60%) and superoxide dismutase (≈50%), glutathione peroxidase activity (≈46.67%) and increased malondialdehyde (≈116.67%) and nitric oxide (≈87.5%) levels in testicular tissues. Furthermore, FIP induced edematous changes and degeneration within the seminiferous tubules, hyperplasia, vacuolations, and apoptosis in the epididymides. In addition, FIP exposure upregulated interleukin-1β (IL-1β), nitric oxide synthase 2 (NOS), caspase-3 (Casp3) and downregulated the Burkitt-cell lymphomas (BCL-2), inhibin B proteins (IBP), and androgen receptor (Ar) mRNA expressions Casp3, nitric oxide synthase (iNOS), ionized calcium-binding adapter molecule 1(IBA1), and IL-1β immunoreactions were increased. Also, reduction of proliferating cell nuclear antigen (PCNA), mouse vasa homologue (MVH), and SOX9 protein reactions were reported. Interestingly, CeNPs diminished the harmful impacts of FIP on testicular tissue by decreasing lipid peroxidation, apoptosis and inflammation and increasing the antioxidant activities. The findings reported herein showed that the CeNPs might serve as a supposedly new and efficient protective agent toward reproductive toxicity caused by the FIP insecticide in white male rats