Rifampin-warfarin interaction in a mitral valve replacement patient receiving rifampin for infective endocarditis: a case report

Warfarin therapy is associated with many drug interactions that may cause a significant alteration in its anticoagulant effect. Rifampin is a widely used antimicrobial that has major interactions with several medications including warfarin due to its strong P-glycoprotein and liver enzyme inducer activity especially on CYP2C9, CYP3A4, CYP1A2 and CYP2C19. We report a case of a 34-year-old Sri Lankan female chronically treated with warfarin for her mitral valve replacement. The patient developed infective endocarditis and was started on a 6-week treatment with rifampin along with other antibiotics. Warfarin dose was increased from 52.5 to 210 mg/week over the course of the rifampin therapy, however, the INR remained subtherapeutic throughout the whole period and reached 2.4 by the end of rifampin therapy. Anticoagulation management was challenging in the period following the end of rifampin therapy as well, and multiple dose adjustments starting with an increase and followed by reduction were required till she was stable on an 80 mg/week warfarin dose 5 weeks post-rifampin therapy. Our findings suggest the importance of close monitoring of warfarin therapy during and after the use of rifampin to minimize the risks of under and over-anticoagulation and improve the safety and efficacy of warfarin therapy.Scopu

Diagnostic accuracy of cone-beam computed tomography using different voxel sizes versus digital intraoral radiography in detection of vertical root fractures of teeth with metallic post

Background: Conventional radiographs are not an efficient diagnostic method to detect vertical root fracture (VRF). Cone-beam computed tomography (CBCT) overcomes the limitations of conventional radiography in the detection of VRF. In CBCT, metallic structures can cause artifacts in the images. Aim: This study aimed to determine the diagnostic accuracy of CBCT using different voxels in the detection of VRFs of teeth with metallic posts compared to digital intraoral radiography. Materials and Methods: A total of 120 single-rooted extracted human teeth were obtained and endodontically treated, then placed in an acrylic block and metallic posts were inserted. After post insertion, the teeth roots were divided into two groups one with induced VRFs and the other having intact roots with the posts inserted. Then, each tooth was coded and imaged 3 times using CBCT and digital periapical radiography (DPR). Results: DPR showed statistically significantly lower diagnostic accuracy than CBCT, and changing the voxel did not improve the diagnostic accuracy. Conclusion: In case of suspicious VRFs, CBCT is recommended to detect the presence of fractures. Clinical Significance: Since most teeth suspected to have VRFs are endodontically treated and have a metallic post in the root canal, fracture detection may pose a challenge CBCT resolves this issue

Endowment and its Impact on Intellectual and Educational Development: A Study of the Islamic Sharia

تناول البحث بيان معنى الوقف ومشروعيته وأنواعه وأركانه وما يشترط فيه، وأهميته وآثاره الإيجابية في واقعنا المعاصر، حيث إن للوقف أهميةً كبيرة في التنمية؛ فقد شمل جوانب الحياة جميعها دينية واجتماعية وثقافية واقتصادية وعسكرية، ووضَّحَ المراد بالتنمية، وهي: تعنى الفعل التطويري بأشكاله المختلفة الذي يؤدى إلى رفع مستوى المجتمع من مستوى أدنى نسبيا  إلى مستوى أعلى نسبيًّا، ومن سماتها: الشمولية- والتطور –والاستمرارية -ومراعاة احتياجات الأجيال القادمة – وتلبية احتياجات الأفراد، وقد حَثَّتِ الشريعة على التنمية وعدتها واجبًا شرعيًّا؛ لأن بها تحصل الكفاية للأمة وتستغني عن غيرها. وقد وُضِّحَ أيضًا أنَّ للوقف أثرًا في التنمية الفكرية فعن طريق الوقف بُني كثير من المساجد وأُقيمت حلقات العلم، والمدارس ودور التعليم المختلفة والمكتبات التي كان لها أبرز الأثر في نشر العلم الصحيح والثقافة ومحاربة الجهل والبدع والأفكار الدخيلة على المجتمع، وصُرِفَ عليها من ريع الوقف بما يضمن استمرارها في أداء غرضها الذي أُقيمت من أجله وتنميتها، ولعب الوقف دورًا ملموسًا في الاجتهاد والتجديد واستقلال العلماء وصدعهم بالحق، وساهم في بناء الحضارة وتطورها، حيث اتصل بها اتصالًا مباشرًا فأثر فيها وتأثر بها، وتناولت الأسباب التي كانت وراء تراجع دور الوقف في عصرنا الحاضر ومنها: عدم الخبرة في تنمية أموال الوقف، وغياب دور الأمانة، وضعف الوازع الديني عند بعض الأثرياء، وعدم الاهتمام بالمصلحة العامة للمجتمع، وبالجملة فإن الوقف ساعد على التنمية والازدهار في جميع نواحي الحياة في المجتمع الإسلامي.  This research clarifies the meaning of the endowment, its legitimacy, its types, its pillars, its requirements, significance, as well as its positive influence on our contemporary life. Actually, endowment has a great contribution to development; as it covers all aspects and dimensions of life whether being religious, social, cultural, economic or military. It depicts what is meant by development, in other words, developmental act in its various forms that leads to raising the level of society from a relatively lower level to a relatively higher level, and among its features: comprehensiveness - development - sustainability–besides consideringthe needs of future generations – in addition to fulfilling the needs of individuals. The Shariah urges development and considers it as a legal duty; Because it gets enough for the nation and dispenses with others. Furthermore, this study manifests that the endowment had an impact on intellectual development. Through the endowment, many mosques were built, and science circles were established, schools, various education houses and libraries were structured. All these deeds of endowment have a prominent impact in spreading true science and culture besides eradicating ignorance, heresies and ideas alien to society. Substantial amount of money of the endowment were spent to ensure its continuity in fulfilling its purpose for which it was established and its development. The endowment also played a tangible role in ijtihad, innovation, independence of scholars and cracking them with truth. It also played a vital role in building civilization and its developmentin an interactive influential manner from both sides. It also addressed the reasons behind the decline in the role of the endowment in our current era, including: lack of experience in developing endowment funds, the absence of the role of the trust, the weak religious faith of some wealthy people, and the lack of interest in the public interest of society. In conclusion, the endowment helped development and prosperity in all aspects of life in the Islamic society

Bridging vs Non-Bridging with Warfarin Peri-Procedural Management: Cost and Cost-Effectiveness Analyses

The warfarin peri-procedural management in Qatar is predominantly based on bridging (63%), compared to non-bridging. This study sought to perform a first-time cost analysis of current warfarin peri-procedural management practices, including a cost-effectiveness analysis (CEA) of predominant bridging vs predominant non-bridging practices. From the hospital perspective, a one-year decision-analytic model followed the cost and success consequences of the peri-procedural warfarin in a hypothetical cohort of 10,000 atrial fibrillation patients. Success was defined as survival with no adverse events. Outcome measures were the cost and success consequences of the 63% bridging (vs not-bridging) practice in the study setting, ie, Hamad Medical Corporation, Qatar, and the incremental cost-effectiveness ratio (ICER, cost/success) of the warfarin therapy when predominantly bridging based vs when predominantly non-bridging based. The model was based on Monte Carlo simulation, and sensitivity analyses were performed to confirm the robustness of the study conclusions. As per 63% bridging practices, the mean overall cost of peri-procedural warfarin management per patient was USD 3,260 (QAR 11,900), associated with an overall success rate of 0.752. Based on the CEA, predominant bridging was dominant (lower cost, higher effect) over the predominant non-bridging practice in 62.2% of simulated cases, with a cost-saving of up to USD 2,001 (QAR 7,303) at an average of USD 272 (QAR 993) and was cost-effective in 36.9% of cases. Being between cost-saving and cost-effective, compared to predominant non-bridging practices, the predominant use of bridging with warfarin seems to be a favorable strategy in atrial fibrillation patients

Assessing the safety of cracked concrete dams

AbstractThe overall safety of dams depend on several stipulations. One of them is global stability of the dam, which is addressed with approaches like that in (RIDAS, 2017) (the Swedish power companies’ guidelines for dam safety). When designing a new dam, two global failure modes; sliding and overturning should be considered according to RIDAS. However, this is a simplification and other failure modes may exist, such as the combination of sliding and overturning failure. In this combined mode, the dam typically starts to overturn slightly, then as it looses its contact in the upstream area of the footprint, the dam starts to slide. This combined failure mode is yet to be fully addressed in design codes.One additional failure mode that may occur is an internal failure which is caused by material failure of the dam or where existing cracks govern the failure mode. Reinforced concrete structures are expected to crack and hence it likely that such failure mode may occur. The objective of this report is to understand the behavior of a pre-cracked buttress dam under typical loading conditions, and to analyze potential internal failure modes caused by these cracks. Moreover, the validity of using RIDAS design criteria for evaluating the safety of cracked concrete buttress dams will be examined. Finally, this report will study the influence of various possible cracks to study if these are critical and influence the overall dam safety.The stated objectives were investigated by performing analytical calculations and FE-analyses for three different geometries, where each geometry was analyzed with and without pre-existing cracks. The analytical calculations were carried out using MATLAB, to study the two global failure modes suggested by RIDAS: sliding and overturning for the selected geometries. FE-analyses were performed using BRIGADE Plus 6.2 software, where all geometries were studied for all potential global failure modes, including a combination of sliding and overturning failure modes. When comparing results of uncracked and cracked sections, whether it was obtained analytically or by FE-analyses, the influence of cracks in reducing the overall safety of the structure could be clearly highlighted. Moreover, the results comparing analytical solution using RIDAS and FE-analysis did not follow a uniform pattern, therefore, no concrete results could be concluded and further studies to develop more detailed analytical calculation methods were suggested. Finally, the cracks develop between the inspection gangway and the front-plate was proven to have larger influence on the residual mass of the dam, and thus, the overall safety of the dam

Epidemiologische Untersuchungen zur Public Health-Bedeutung von Kryptosporidien von Nutztieren und Menschen in der Ismailia-Kanal Zone Ägyptens

Cryptosporidiosis is an underestimated problem in livestock animals and humans in Egypt. To provide a valid estimate of the frequencies and distributions of Cryptosporidium species and their subtypes in both animals and humans, a sample of smallholder cattle/buffalo herds in the districts of Ismailia province and of diarrheic children attending the province’s district hospitals was investigated. A total of 804 animal samples from 191 herds and 165 human samples were investigated by the Copro-antigen RIDA®QUICK test, followed by PCRs (animals: all RIDA®QUICK test positive + 10% negative) targeting the 18S rDNA and Gp60 genes and PCR-RFLP assays for amplification and differentiation of Cryptosporidium spp. Detailed analyses were carried out for prevalence, distribution, risk factors, and infection dynamics of cryptosporidiosis and involved Cryptosporidium species and subtypes. Results of molecular diagnostic methods were co-analyzed with epidemiological information. Cryptosporidiosis was found to be common in Ismailia province; within herd prevalence was 73.3%, individual animal prevalence 32.2% and prevalence in diarrheic children 49.1%. The pattern of cryptosporidiosis is unique, distinct and multilayered in the province. Two independent transmission cycles exist. Anthroponotic transmission is due to C. hominis. Infection hotspots, however, are not urban but rather rural areas along the province’s major irrigation canal. The zoonotic scenario is characterized by 5 Cryptosporidium species involved, with C. parvum dominating, and by 4 C. parvum subtypes, not all identical in animals and humans. The surprising dominance of the IId allele family in animals and humans points to a likely adaptation of a typical subtype of small ruminants. An endemic cryptosporidiosis situation in livestock is likely, maintained by the predominant smallholder husbandry system, where the frequent exchange between herds reshapes the existence of several Cryptosporidium species and subtypes in animals. This animal scenario is principally mirrored in zoonotic cryptosporidiosis (C. parvum) of humans. Development of control strategies should take notice of the special features identified in animal and human cryptosporidiosis. Strategies will have to be long-term, include hygienic measures at any setting and behavioral change of people, both rural and urban. The introduction of routine testing of stool specimens of diarrheal patients is a realistic short term option.Kryptosporidiose landwirtschaftlicher Nutztiere und der menschlichen Bevölkerung ist ein unterschätztes Problem in Ägypten. Zur Erstellung valider Schätzungen von Häufigkeiten und Verteilungen von Kryptosporidien-Spezies und ihrer Genotypen sowohl in Nutztieren als auch Menschen der Ismailia Provinz Ägyptens wurden Stichproben von Herden ägyptischer Rinder und Büffel des vorherrschenden kleinstbäuerlichen Haltungssystems aus den Distrikten der Provinz und von Kindern mit Durchfall, die stationäre Patienten eines der Distrikthospitäler waren, untersucht. Insgesamt wurden 804 Proben von Tieren aus 191 Herden und 165 Humanproben mit dem Copro-antigen RIDA®QUICK Test gefolgt von auf die 188 rDNA und das Gp60-Gen abzielende PCRs (Tiere: alle RIDA®QUICK Test positiv + 10% negativ) und PCR-RFLP-Assays zur Amplifizierung und Differenzierung von Kryptosporidium spp. untersucht. Detaillierte Analysen wurden zur Prävalenz, Verteilung, Risikofaktoren und Infektionsdynamik von Kryptosporidiose und beteiligter Kryptosporidium-Spezies und Subtypen durchgeführt. Ergebnisse der molekularen Diagnostik wurden zusammen mit epidemiologischen Informationen analysiert. Kryptosporidiose war häufig in der Ismailia-Provinz, die Herdenprävalenz lag bei 73,3%, die Einzeltierprävalenz bei 32.2% und die Prävalenz bei Kindern mit Durchfall bei 49.1%. Das Muster der Kryptosporidiose in der Provinz ist einzigartig, unterschiedlich und mehrschichtig im Vergleich zu anderen Regionen und Ländern. Zwei unabhängige Infektionswege bestehen. C. hominis ist verantwortlich für Mensch-zu- MenschÜbertragungen. Infektions-Hotspots liegen jedoch nicht in urbanen, sondern ländlichen Gegenden entlang des Hauptbewässerungskanals der Provinz. Am zoonotischen Szenarium sind fünf Kryptosporidium-Spezies, dominiert von C. parvum, und 4 C. parvum-Subtypen, zum Teil unterschiedlich in Tieren und Menschen, beteiligt. Die überraschende Dominanz der IId Allel-Familie in Tieren und Menschen deutet auf eine mögliche Adaptation eines typischen Subtyps kleiner Wiederkäuer hin. Eine endemische Kryptosporidiose-Situation in landwirtschaftlichen Nutztieren ist naheliegend, die durch das vorherrschende Kleinstbauern-System unterstützt wird, das, durch unregulierte Kontakte von Herden, Umformung und Austausch verschiedener Kryptosporidium- Spezies und Subtypen in Tieren fördert. Dieses Tier-Szenarium spiegelt sich grundsätzlich in der zoonotischen Kryptosporidiose durch C. parvum auch bei Menschen wieder. Die Entwicklung von Kontrollstrategien in Ägypten sollte die speziellen Merkmale der Kryptosporidiose in Tieren und Menschen berücksichtigen. Strategien müssen langfristig angelegt sein und hygienische Maßnahmen auf allen Ebenen sowie Verhaltensänderungen sowohl der ländlichen wie städtischen Bevölkerungen einschliessen. Die Einführung von Routineuntersuchungen von Stuhlproben von Patienten mit Durchfall ist eine realistische, kurzfristig wirksame Option

Assessing the safety of cracked concrete dams

AbstractThe overall safety of dams depend on several stipulations. One of them is global stability of the dam, which is addressed with approaches like that in (RIDAS, 2017) (the Swedish power companies’ guidelines for dam safety). When designing a new dam, two global failure modes; sliding and overturning should be considered according to RIDAS. However, this is a simplification and other failure modes may exist, such as the combination of sliding and overturning failure. In this combined mode, the dam typically starts to overturn slightly, then as it looses its contact in the upstream area of the footprint, the dam starts to slide. This combined failure mode is yet to be fully addressed in design codes.One additional failure mode that may occur is an internal failure which is caused by material failure of the dam or where existing cracks govern the failure mode. Reinforced concrete structures are expected to crack and hence it likely that such failure mode may occur. The objective of this report is to understand the behavior of a pre-cracked buttress dam under typical loading conditions, and to analyze potential internal failure modes caused by these cracks. Moreover, the validity of using RIDAS design criteria for evaluating the safety of cracked concrete buttress dams will be examined. Finally, this report will study the influence of various possible cracks to study if these are critical and influence the overall dam safety.The stated objectives were investigated by performing analytical calculations and FE-analyses for three different geometries, where each geometry was analyzed with and without pre-existing cracks. The analytical calculations were carried out using MATLAB, to study the two global failure modes suggested by RIDAS: sliding and overturning for the selected geometries. FE-analyses were performed using BRIGADE Plus 6.2 software, where all geometries were studied for all potential global failure modes, including a combination of sliding and overturning failure modes. When comparing results of uncracked and cracked sections, whether it was obtained analytically or by FE-analyses, the influence of cracks in reducing the overall safety of the structure could be clearly highlighted. Moreover, the results comparing analytical solution using RIDAS and FE-analysis did not follow a uniform pattern, therefore, no concrete results could be concluded and further studies to develop more detailed analytical calculation methods were suggested. Finally, the cracks develop between the inspection gangway and the front-plate was proven to have larger influence on the residual mass of the dam, and thus, the overall safety of the dam

Effect of applying metal artifact reduction algorithm in cone beam computed tomography in detection of vertical root fractures of teeth with metallic post versus digital intraoral radiography

Background: Conventional radiographs are not an efficient diagnostic imaging modality to detect vertical root fracture. Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality that overcomes the limitations of conventional radiography in the detection of vertical root fractures (VRFS), although metallic structures produce artifacts in the produced images and since most of the teeth with VRF are endodontically treated and have metallic posts in root canal so fracture detection may be difficult. Aim: This study aimed to determine the diagnostic accuracy of CBCT using metal artifact reduction algorithm in detection of VRF of teeth with metallic posts compared to digital intraoral radiography. Materials and Methods: One hundred and twenty single-rooted extracted human teeth were endodontically treated then placed in an acrylic block and metallic posts were inserted. The teeth roots were divided into two groups; one with induced VRF and the other having intact roots. Then, each tooth was coded and imaged three times using CBCT with and without metal artifact reduction algorithm and digital periapical radiography. Data were collected and statistically analyzed. Results: Digital periapical radiography showed statistically significantly lower diagnostic accuracy than CBCT modalities (P ≤ 0.05). The use of metal artifact reduction algorithm improved the diagnostic accuracy from CBCT1 to CBCT2 but with no statistically significant difference (P ≥ 0.05). Conclusion: From the study, we can conclude that in case of presence of metallic posts, CBCT with metal artifact reduction algorithm can improve detection of VRF

Prognostic value of plasma brain natriuretic peptide in patients with stable chronic obstructive pulmonary disease

Introduction: Early detection of pulmonary hypertension or cor pulmonale could be beneficial in managing patients with chronic obstructive pulmonary disease (COPD) because the prognosis of these conditions is poor. Plasma brain natriuretic peptide (BNP) levels are elevated in patients with PH secondary to chronic lung diseases. Aim: The aim of the present study was to investigate the use of plasma BNP levels as a prognostic marker in patients with stable COPD. Methods: Plasma BNP was measured in controls and patients with stable COPD stage II, III and IV (according to the Global Initiative for Chronic Obstructive Lung Disease classification). Echocardiography, arterial blood gas analysis, and spirometry were also performed for COPD patients. Results: The study included 57 male patients with stable COPD; 19 had stage II COPD, 21 had stage III COPD, and 17 had stage IV COPD. Twenty age-matched healthy male smokers were enrolled as a control group. The plasma BNP levels were significantly higher in COPD patients compared to controls. The plasma BNP levels in COPD patients increased with disease severity. Plasma BNP levels significantly correlated with FEV1%, PaCO2, PaO2 and pulmonary artery systolic pressure. Conclusions: Plasma BNP levels increased significantly with disease severity, progression of chronic respiratory failure, and secondary pulmonary hypertension in patients with stable COPD. These results suggest that plasma BNP can be a useful prognostic marker to monitor COPD progression and identify cases of secondary pulmonary hypertension in patients with stable COPD