Myocardial siderosis in thalassemia major remains the leading cause of death in developing countries. Once heart failure develops, the outlook is usually poor with precipitous deterioration and ...death. Cardiovascular magnetic resonance (CMR) can measure cardiac iron deposition directly using the magnetic relaxation time T2*. This allows earlier diagnosis and treatment and helps to reduce mortality from this cardiac affection. This study aims to determine the prevalence of cardiac siderosis in Egyptian patients who are heavily iron loaded and its relation to liver iron concentration, serum ferritin, and left ventricular ejection fraction. Eighty-nine β-thalassemia patients receiving chelation therapy (mean age of 20.8 ± 6.4 years) were recruited in this study. Tissue iron levels were determined by CMR with cardiac T2* and liver R2*. The mean ± standard deviation (range) of cardiac T2* was 28.5 ± 11.7 ms (4.3 to 53.8 ms), the left ventricular ejection fraction (LVEF) was 67.7 ± 4.7 % (55 to 78 %), and the liver iron concentration (LIC) was 26.1 ± 13.4 mg Fe/g dry weight (dw) (1.5 to 56 mg Fe/g dw). The mean serum ferritin was 4,510 ± 2,847 ng/ml (533 to 22,360 ng/ml), and in 83.2 %, the serum ferritin was >2,500 ng/ml. The prevalence of myocardial siderosis (T2* of <20 ms) was 24.7 % (mean age 20.9 ± 7.5 years), with mean T2* of 12.7 ± 4.4 ms, mean LVEF of 68.6 ±5.8 %, mean LIC of 30.9 ± 13 mg Fe/g dw, and median serum ferritin of 4,996 ng/ml. There was no correlation between T2* and age, LVEF, LIC, and serum ferritin (
P
= 0.65,
P
= 0.085,
P
= 0.99, and
P
= 0.63, respectively). Severe cardiac siderosis (T2* of <10 ms) was present in 7.9 %, with a mean age of 18.4 ± 4.4 years. Although these patients had a mean T2* of 7.8 ± 1.7 ms, the LVEF was 65.1 ± 6.2 %, and only one patient had heart failure (T2* of 4.3 ms and LVEF of 55 %). LIC and serum ferritin results were 29.8 ± 17.0 mg/g and 7,200 ± 6,950 ng/ml, respectively. In this group of severe cardiac siderosis, T2* was also not correlated to age (
P
= 0.5), LVEF (
P
= 0.14), LIC (
P
= 0.97), or serum ferritin (
P
= 0.82). There was a low prevalence of myocardial siderosis in the Egyptian thalassemia patients in spite of very high serum ferritin and high LIC. T2* is the best test that can identify at-risk patients who can be managed with optimization of their chelation therapy. The possibility of a genetic component for the resistance to cardiac iron loading in our population should be considered.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We report a rare case of a patient presenting with a nonmuscle invasive papillomatosis transitional cell carcinoma of the bladder in the second trimester of pregnancy. We describe the management ...dilemmas encountered and the challenging treatment option selected to optimize outcome for the patient and infant. Close collaboration between urologists, obstetricians and medical colleagues is needed for optimal, safe and effective management of bladder tumours during pregnancy.
The chronic diseases constitute pathological social phenomena as they have an impact on the organic construction for individuals; They make their roles and functions in the society regress and weak ...due to the results made by these diseases on their social, psychological, and economic lives as well. They make several problems which lead to struggles be it the patient with himself or with people surrounding him. Amongst the most known and dangerous diseases is kidney failure which is included at the last stage of kidney disease; The kidney completely loses its function and work leading by this to dialysis with medical equipments and apparatus. Undoubtedly, the patient, at the time of being acquainted with the disease, is exposed to psychological trauma such as: not accepting and not adapting to the disease. Following by social problems by time owed to the fact that the patient will not play his ordinary role whether inside the family or outside it leading him accordingly to pressures preventing him from adapting to the social reality. Therefore, we pose the following question: What are the major psychological and social problems that patients with kidney failure are suffering from?
Implementing the International Organization for Standardization (ISO9000) in Bahrain Council of Representatives offers many prospects to diversify Bahrain’s Parliament and raise management ...development and duties. This paper entirely explores the potential items of customer focus, leadership, people’s involvement, and continual improvement, which will be used as a scale to measure the impact of ISO 9000 on Bahrain Council of Representatives performance and other private sector organizations to recognize that potential. This research work is mainly designed based on one of quantitative approaches, which is the survey questionnaire. Data was collected from Council of Representative’s Staff in the Kingdom of Bahrain by distributing the questionnaire randomly to Council of Representative’s employees and consequently analyzed through quantitative analysis methods. Overall findings show that all items appear to be useful and contribute to the overall reliability of their corresponding construct. This research work will help define best items and constructs for stakeholders’ who are interested in applying ISO9000 standards in the organizations, prioritize improvement of employees and enhance performance relative to shareholders’ expectations and liable organization development. This paper fills a prevailing gap by providing a distinctive reliable assessment scale of such effectiveness and comprehensive assessment measure through an organized analysis of pertinent arcade data in the kingdom of Bahrain.
Background
Salivary testosterone (Sal-T) has been established as a noninvasive biomarker in the diagnosis of androgen deficiency in men. However, available data on its utility in adolescent boys with ...constitutional delay of growth and puberty (CDGP) are not conclusive. Our study was designed to compare salivary versus serum measurements of free testosterone (FT) from the samples collected simultaneously and correlated them with the clinical parameters in boys with CDGP.
Patients and methods
The study enrolled 25 adolescent boys with CDGP and 20 healthy controls matched for age and sex. Weight, height, BMI, testicular volume, bone age, serum follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were assessed. Simultaneous morning saliva and serum samples were obtained for FT measurements by radioimmunoassay and Sal-T by the enzyme-linked immunosorbent assay technique.
Results
Adolescent boys with CDGP had significantly lower Sal-T and serum free-T than normal controls (
P
<0.001). Sal-T positively correlated with BMI, bone age, testicular volume, serum FSH, LH, and FT. With multiple regression analysis BMI, FSH, LH, and serum FT remained independently correlated with Sal-T. Using the receiver operating characteristic curve, Sal-T was found to be more sensitive than serum FT (76 vs. 69%) in the clinical assessment of boys with CDGP.
Conclusion
Our data shows that Sal-T strongly correlates with FT and provides a sensitive, simple, noninvasive, and diagnostic approach for androgen status in adolescent boys with CDGP.
This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including ...subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In this paper, we introduce finite energy classes of quaternionic
$m$-plurisubharmonic functions of Cegrell type and define the quaternionic
$m$-Hessian operator on some Cegrell's classes. We use the ...variational approach
to solve the quaternionic $m$-Hessian equation when the right-hand side is a
positive Radon measure.
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