Concise Review: Cell Therapy for Critical Limb Ischemia: An Integrated Review of Preclinical and Clinical Studies

Critical limb ischemia (CLI), the most severe form of peripheral artery disease, is characterized by pain at rest and non-healing ulcers in the lower extremities. For patients with CLI, where the extent of atherosclerotic artery occlusion is too severe for surgical bypass or percutaneous interventions, limb amputation remains the only treatment option. Thus, cell-based therapy to restore perfusion and promote wound healing in patients with CLI is under intense investigation. Despite promising preclinical studies in animal models, transplantation of bone marrow (BM)-derived cell populations in patients with CLI has shown limited benefit preventing limb amputation. Early trials injected heterogenous mononuclear cells containing a low frequency of cells with pro-vascular regenerative functions. Most trials transferred autologous cells damaged by chronic disease that demonstrated poor survival in the ischemic environment and impaired function conferred by atherosclerotic or diabetic co-morbidities. Finally, recent preclinical studies suggest optimized blood vessel formation may require paracrine and/or structural contributions from multiple progenitor cell lineages, angiocrine-secretory myeloid cells derived from hematopoietic progenitor cells, tubule-forming endothelial cells generated by circulating or vessel-resident endothelial precursors, and vessel-stabilizing perivascular cells derived from mesenchymal stem cells. Understanding how stem cells co-ordinate the myriad of cells and signals required for stable revascularization remains the key to translating the potential of stem cells into curative therapies for CLI. Thus, combination delivery of multiple cell types within supportive bioengineered matricies may represent a new direction to improve cell therapy strategies for CLI. Stem Cells 2018;36:161–171

A Patient Presented with High Fever and Bloody Pericardial Effusion (Hemorrhagic Pericarditis)

We report a case of hemorrhagic pericarditis caused by Mycobacterium tuberculosis infection of the pericardium which is an extremely rare diagnosis. The literature review showed that there were rare cases of tuberculosis-causing hemorrhagic pericarditis, but the diagnosis was made either postmortem or not firmly diagnosed. Our patient was diagnosed as hemorrhagic pericarditis due to M. tuberculosis, he was treated and was discharged

Depression Among Medical Students When Compared to Other Students at West Bank Universities

Background: Depression has been an inconspicuous yet crucial concern in our society, particularly among medical students, who are the future health care providers. Therefore, our research investigated the following question: “What influence do socio-demographic and academic factors have on depression levels among medical students compared to other students, at West Bank Universities?” Objectives: This research aimed to assess the previous influence, identify and compare the prevalence of depression among medical and non-medical students. More importantly, to investigate whether medical students have the propensity for depression, or it is just a false perception of depression symptoms? Methods: A quantitative, cross-sectional study was conducted on a sample of 714 medical and non-medical students (comparative group), from Al-Quds and Al-Najah Universities. Data was collected using a questionnaire that includes: the investigation of research questions and related factors, and the computations of depression using Beck Depression Inventory. The data were analyzed using SPSS (VER:20). Results: About one-third of our sample’s medical students suffered from some form of depression; in particular, moderate depression appeared to be relatively high (18.7% and 25.5% in medical and control, respectively). At all depression levels, there appeared to be a significant difference, with a lower prevalence of depression in medical students compared to the control group, except that medical students suffered from a higher rate of mild mood disturbances (25.1%) than non-medical students (14.6%). Furthermore, there was a significant relationship (α ≤0.05) between higher prevalence of depression and female gender, lower GPA, low economic status, and lack of psychological support. Other variables, such as accommodation and year of study, showed insignificant relationships with depression. Conclusion: Based on these results, we conclude that the prevalence of depression appears to be high regardless of university or specialty, reflecting the high depression rates in Palestinian society. Higher prevalence of depression among non-medical students can be attributed to medical students’ adaptation to stress from high school, as both universities accept high scores. The researchers recommend medical students to practice their hobbies and participate in extracurricular activities as both factors showed a significant decrease in depression. Finally, the perception of higher depression among medical students seems to be false, according to our results

Compliance with antimicrobials de-escalation in septic patients and mortality rates: an old subject revisited

Background To compare the recent de-escalations rates with a six-year earlier study, and mortality associated with de-escalation. Methods Settings A prospective multicenter study including septic patients, all were on broad-spectrum antimicrobials (BSA). Excluded from the study patients on antimicrobial prophylaxis, and patients without a microbiological diagnosis, or bacteria were solely BSA-susceptible. The study team made recommendations for antimicrobials de-escalation to the treating physician(s) must an opportunity loomed. Results 182 patients were available for analysis. De-escalation was achieved in 43 (24%) patients. The clinical diagnoses, comorbidities, commonly used antimicrobials, the microbiological diagnoses were not different between the two groups (patients with and without de-escalation). Logistic regression analysis showed no correlation between bacterial species and de-escalation (Nagelkerke R2 = 0.076). Relapsing sepsis and reinfection were not different (P > 0.05). The in-hospital mortality rates for the de-escalated patients were lower (P = 0.015), not on day 30 (P = 0.354). The length of the ICU stay and ward stay were not different (P >0.05), but more de-escalated patients were discharged home from the ICU (P = 0.034), however, patients without de-escalation were discharged more from the ward (P = 0.002). Conclusion De-escalation rates increased within six years from 6.7% - 24% (P = 0.000), with added benefits of shorter ICU stay and less in-hospital mortalit

Method for the fast determination of bromate, nitrate and nitrite by ultra performance liquid chromatography–mass spectrometry and their monitoring in Saudi Arabian drinking water with chemometric data treatment

A rapid, sensitive and precise method for the determination of bromate (BrO3(-)), nitrate (NO3(-)) and nitrite (NO2(-)) in drinking water was developed with Ultra performance Liquid Chromatography-Mass Spectrometry (UPLC-ESI/MS). The elution of BrO3(-), NO3(-) and NO2(-) was attained in less than two minutes in a reverse phase column. Quality parameters of the method were established; run-to-run and day-to-day precisions were <3% when analysing standards at 10µgL(-1). The limit of detection was 0.04µg NO2(-)L(-1) and 0.03µgL(-1) for both NO3(-)and BrO3(-). The developed UPLC-ESI/MS method was used to quantify these anions in metropolitan water from Saudi Arabia (Jeddah, Dammam and Riyadh areas) and commercial bottled water (from well or unknown source) after mere filtration steps. The quantified levels of NO3(-) were not found to pose a risk. In contrast, BrO3(-) was found above the maximum contaminant level established by the US Environmental Protection Agency in 25% and 33% of the bottled and metropolitan waters, respectively. NO2(-) was found at higher concentrations than the aforementioned limits in 70% and 92% of the bottled and metropolitan water samples, respectively. Therefore, remediation measures or improvements in the disinfection treatments are required. The concentrations of BrO3(-), NO3(-) and NO2(-) were mapped with Principal Component analysis (PCA), which differentiated metropolitan water from bottled water through the concentrations of BrO3(-) and NO3(-) mainly. Furthermore, it was possible to discriminate between well water; blend of well water and desalinated water; and desalinated water. The point or source (region) was found to not be distinctive

The need for national medical licensing examination in Saudi Arabia

<p>Abstract</p> <p>Background</p> <p>Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate.</p> <p>Discussion</p> <p>We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia.</p> <p>Conclusion</p> <p>The driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate.</p

The prevalence of adaptive immunity to COVID-19 and reinfection after recovery - a comprehensive systematic review and meta-analysis.

This study aims to estimate the prevalence and longevity of detectable SARS-CoV-2 antibodies and T and B memory cells after recovery. In addition, the prevalence of COVID-19 reinfection and the preventive efficacy of previous infection with SARS-CoV-2 were investigated. A synthesis of existing research was conducted. The Cochrane Library, the China Academic Journals Full Text Database, PubMed, and Scopus, and preprint servers were searched for studies conducted between 1 January 2020 to 1 April 2021. Included studies were assessed for methodological quality and pooled estimates of relevant outcomes were obtained in a meta-analysis using a bias adjusted synthesis method. Proportions were synthesized with the Freeman-Tukey double arcsine transformation and binary outcomes using the odds ratio (OR). Heterogeneity was assessed using the I and Cochran's Q statistics and publication bias was assessed using Doi plots. Fifty-four studies from 18 countries, with around 12,000,000 individuals, followed up to 8 months after recovery, were included. At 6-8 months after recovery, the prevalence of SARS-CoV-2 specific immunological memory remained high; IgG - 90.4% (95%CI 72.2-99.9, I = 89.0%), CD4+ - 91.7% (95%CI 78.2-97.1y), and memory B cells 80.6% (95%CI 65.0-90.2) and the pooled prevalence of reinfection was 0.2% (95%CI 0.0-0.7, I = 98.8). Individuals previously infected with SARS-CoV-2 had an 81% reduction in odds of a reinfection (OR 0.19, 95% CI 0.1-0.3, I = 90.5%). Around 90% of recovered individuals had evidence of immunological memory to SARS-CoV-2, at 6-8 months after recovery and had a low risk of reinfection

A lightweight neural network with multiscale feature enhancement for liver CT segmentation

Segmentation of abdominal Computed Tomography (CT) scan is essential for analyzing, diagnosing, and treating visceral organ diseases (e.g., hepatocellular carcinoma). This paper proposes a novel neural network (Res-PAC-UNet) that employs a fixed-width residual UNet backbone and Pyramid Atrous Convolutions, providing a low disk utilization method for precise liver CT segmentation. The proposed network is trained on medical segmentation decathlon dataset using a modified surface loss function. Additionally, we evaluate its quantitative and qualitative performance; the Res16-PAC-UNet achieves a Dice coefficient of 0.950 ± 0.019 with less than half a million parameters. Alternatively, the Res32-PAC-UNet obtains a Dice coefficient of 0.958 ± 0.015 with an acceptable parameter count of approximately 1.2 million.This publication was made possible by NPRP-11S-1219-170106 from the Qatar National Research Fund (a member of Qatar Foundation). The findings herein reflect the work, and are solely the responsibility of the authors

Global survey of the roles, satisfaction, and barriers of home healthcare nurses on the provision of palliative care

Background: the World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: to globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: needs assessment survey. Setting/Subjects: five hundred thirty-two home health care nurses in 29 countries. Measurements: a needs assessment, developed through literature review and cognitive interviewing. Results: nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: it is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity